Brain Injury Lawyer - New York

Brain Injury Legislative Update

The following is the Legislative Update supplied by the Brain Injury Association of America for this week:

Dear Advocates:

Two weeks remain until Congress leaves for Memorial Day recess, and legislative activity is expected to center on efforts to pass a war supplemental spending bill as well as potentially achieving progress on a fiscal 2009 budget conference report.

Several events and developments related to traumatic brain injury took place this week in our nation’s capital.

On Tuesday, the House Ways and Means Subcommittee on Health held a hearing on the issue of competitive bidding of durable medical equipment under the Medicare Fee-For-Service program.  As a member of the Consortium for Citizens with Disabilities (CCD), BIAA signed on to several letters urging Congress to ensure that the Medicare competitive bidding program does not decrease access to and the quality of assistive devices.

Also this week, Democrats included legislation which would place a moratorium until March 2009 on several harmful Medicaid regulations (H.R. 5613), in the FY 2008 war supplemental appropriations bill.  BIAA continues to strongly endorse H.R. 5613 and supports efforts to keep the bill in the war supplemental legislation as it moves towards final passage, expected within the next two weeks.
In addition, BIAA Government Affairs Associate Robert Demichelis attended “Brain Pacemakers:  A Promising Approach and a New Era of Hope for Neurological and Psychiatric Disorders,” a symposium on deep brain stimulation sponsored by The Office on Disability, U.S. Department of Health and Human Services and the Cleveland Clinic Center for Neurological Restoration.

As a final note, BIAA continues to wait to see if Congress will be able to agree on a budget this year before sending out its Legislative Action Alert on FY 2009 TBI Appropriations.  In the meantime, BIAA has signed on to a coalition letter urging Appropriations Committee Chairs in both chambers to allocate an additional $15 billion over last year’s funding levels for the Labor-HHS-Education Subcommittees.

Brain Injury Association of America: Legislative Update

The Brain Injury Association of America has requested that I post the following summary of this week's legislative activity. 

This week marked a major legislative victory for the brain injury community, as President Bush officially signed into law legislation reauthorizing the TBI Act (S. 793) on Monday, April 28!  Congratulations to all BIAA state affiliates, advocates, and national stakeholders who helped make TBI Act reauthorization a reality.  To view a copy of BIAA’s official press release applauding this major accomplishment, please visit the brain injury association of america web site.

In other exciting news, BIAA proudly endorsed The Caring for Wounded Warriors Act of 2008 (S. 2921), legislation introduced on Monday, April 28 by Senator Hillary Rodham Clinton which would increase support for family caregivers of servicemembers with TBI.  Several recommendations made by BIAA during the legislative drafting process were incorporated into the bill.  A copy of BIAA’s Letter of Endorsement for S. 2921 will be available shortly on the brain injury association web site.

Also this week, a report was released by the Department of Veterans Affairs Inspector General which found that the VA is not providing the necessary standard of support and long-term follow-up assistance needed by veterans with TBI and their families.

In addition, after the House of Representatives passed by a veto-proof margin last week important legislation which would place a moratorium until March 2009 on several harmful Medicaid regulations (H.R. 5613), the fate of the bill was left up to the Senate.  Earlier this week, Senate Majority Leader Harry Reid (D-NV) attempted to bring the bill up on the Unanimous Consent Calendar, but this attempt was blocked by Senator Coburn (R-OK).  Now there is an effort to get the bill included in the FY 2008 Supplemental Appropriations bill.  BIAA continues to strongly endorse H.R. 5613 and supports efforts to include the bill in the FY 2008 Supplemental Appropriations bill.

As a final note, BIAA is waiting to see if Congress will be able to establish a budget this year before sending out its Legislative Action Alert on FY 2009 TBI Appropriations.  There is speculation that Congress may indeed be able to achieve a budget agreement in the upcoming next few weeks, and BIAA’s Appropriations Action Alert will be sent out shortly thereafter.

Traumatic Brain Injury Act Signed into Law

Late Monday, the President signed the Traumatic Brain Injury (TBI) Act into Law.

S. 793, the "Traumatic Brain Injury Act of 2008," authorizes appropriations and makes changes to the Department of Health and Human Services programs that provide grants for State programs for: tracking and reporting of brain injuries; and brain injury rehabilitation.

Our thanks should be extended to all those who have worked so hard to see that this act was reauthorized,  especially to our national organization, the Brain Injury Association of America whose leadership spearheaded efforts to get the act passed and to U.S. Rep. Bill Pascrell, Jr. (D-NJ-), the Co-Chairman of the Congressional Brain Injury Task Force who was the prime sponsor of this legislation.

Here are some comments from Rep. Pascrell:  “After two years of fighting to reauthorize the TBI Act, I am pleased that the President has joined me to approve an extension of federal services and care for brain injury victims”.  “With thousands of brain injury survivors returning from military service and 5.3 million Americans suffering from TBI here at home, it is more critical than ever for the federal government to prioritize brain injury prevention and rehabilitation.” 

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Brain Injury Legislative Update

The following information has been posted at the request of the Brain Injury Association of America:

Dear Advocates:

After  legislation to reauthorize the Traumatic Brain Injury (TBI) Act successfully passed Congress on April 10, the bill still needs to be considered by the President for his signature into law.  BIAA anticipates this consideration will occur within the next week, and is closely monitoring the situation.
This week the House of Representatives passed by a veto-proof margin H.R. 5613, important legislation which would place a moratorium until March 2009 on seven harmful Medicaid regulations issued by the Department of Health and Human Services.  BIAA issued a Legislative Action Alert earlier this week before the vote encouraging advocates to urge their Representative to vote YES on the bill.  The fate of the bill is now up to the Senate.

Also this week, BIAA submitted written testimony to the Senate Appropriations Subcommittee in charge of funding TBI programs within the Department of Health and Human Services and the Department of Education.  BIAA’s testimony urges an increase in funding in Fiscal Year 2009 for programs authorized through the TBI Act, as well as TBI research programs conducted within the National Institute on Disability and Rehabilitation Research (NIDRR).

In addition, a representative of BIAA was invited to attend an event hosted by President George W. Bush on Thursday, April 24, at the White House.  The inspiring event honored a group of wounded warriors as they kicked off the Wounded Warrior Project’s second annual “Soldier Ride:  White House to Light House Challenge.”

And lastly, BIAA was proud to sign on as a supporter of the National Shaken Baby Syndrome Awareness Week Resolution (S. Res. 518), which passed the Senate on Monday.  The Resolution, introduced by Senator Dodd (D-CT), dedicates this week (the week of April 21st through 25th) to raise awareness of Shaken Baby Syndrome and to ultimately eliminate its occurrence.

Brain Injury Federal Legislative Update

The Brain Injury Association of America has requested that I circulate the following legislative update concerning brain injury legislation and other important brain injury related matters occuring on capital hill this week:

Dear Advocates:

After legislation to reauthorize the Traumatic Brain Injury (TBI) Act successfully passed Congress last week, the bill still needs to be considered by the President for his signature into law.  BIAA anticipates this consideration will occur in the very near future.

This week saw major activity occur on H.R. 5613, legislation recently introduced which would place a moratorium until March 2009 on seven Medicaid regulations issued by the Department of Health and Human Services.  On Wednesday, the bill was unanimously approved by the full House Energy and Commerce Committee, setting up a potential veto showdown with the White House.  BIAA has strongly endorsed this legislation and submitted an official letter of endorsement to the bill’s sponsors, Rep. Dingell (D-MI) and Rep. Murphy (R-PA), last week.

Also this week, The Rand Corporation published an important comprehensive study of the mental health and cognitive needs of U.S. servicemembers returning from Afghanistan and Iraq.  This groundbreaking study - which focuses specifically on the post-deployment health-related needs and economic costs associated with post traumatic stress disorder (PTSD), major depression and TBI - estimates that 320,000 servicemembers may have experienced TBI as a result of recent combat operations.

Senate and House Pass Traumatic Brain Injury Act

In some great news, the Senate today jointed the House of Representatives and passed legislation to reauthorize the Traumatic Brain Injury Act (S. 793).  The vote in the House was 392-1.  The bill now goes to the President for his signature.

The following message was released by the Brain Injury Association of America:

The bill authorizes ongoing CDC, NIH and HRSA TBI programs over the period of FY 2009 through FY 2012. 

The bill also authorizes a new study by the CDC and the NIH in collaboration with the Department of Defense and the Department of Veterans Affairs to identify the incidence of brain injury among our nation’s veterans, especially veterans of Iraq and Afghanistan.  The purpose of this study is to ensure that national research takes veterans into account and that current information about diagnostic tools and treatments are shared between the civilian and military scientific communities.

Much thanks should go to the hard work of the Brain Injury Association of America in getting this vital legislation passed.

Brain Injury Association of America Urgent Legislative Alert

The Brain Injury Association of America has just learned that the TBI Act Reauthorization bill is scheduled for consideration by the full House of Representatives on Tuesday, April 8, 2008. 

The bill is due to be on the House floor Tuesday afternoon around 2:30pm under suspension of the rules, and will appear as S. 793 (the Senate number of the bill).

Urge your Representative to vote YES on S. 793, and reauthorize the TBI Act!!! 

You can click here to contact your representative.

Brain Injury Association of America: Important Request

I received the following important request today from the Brain Injury Association of America:

Recently, the National Institute on Disability and Rehabilitation Research (NIDRR) appears to be deemphasizing medical rehab research, including valuable research related to TBI.  BIAA is working as part of a coalition of advocacy groups to send NIDRR a message that resources for medical rehabilitation research (referred to by NIDRR as "health and function" research) needs to be increased, not decreased.  We need your help!

In the past six months, NIDRR has eliminated funding for four Rehabilitation Research and Training Centers (RTCs) focused on medical rehabilitation research, including centers focused on neuromuscular research, arthritis, TBI community reintegration, and spinal cord injury. Four additional medical rehab RTCs (stroke, MS, aging with a disability, and psychiatric aspects of disability) have been delayed and NIDRR intends to announce these grants with a greater focus on employment and vocational rehab.

As an advocate for increased TBI services and research, you are encouraged to join NIDRR's national meeting/conference call on NIDRR's long range plan scheduled for Wednesday, March 19th, from 1:00 to 5:00 p.m. and express your views. The toll-free conference call number is (800) 762-6085. An operator will ask if you would like to submit input or just listen to the event. The operator will track the order of the people who want to provide input.

(Note: There are other ways to submit comments as well by the end of March if you cannot make the call.  Please contact Laura Schiebelhut, BIAA's Director of Government Affairs, if you have questions.)

We suggest making some or all of the following points:

1. NIDRR has served as the nation’s lead federal agency on rehabilitation and disability research  - including valuable research on TBI - and as such has maintained a broad portfolio of research as reflected in its current Long-Range Plan. This research portfolio includes three broad domains designed to enhance the quality of life of persons with disabilities in the areas of employment, community living, and health and function, including medical rehabilitation research.

2. This approach is to be commended as it recognizes the critical interplay between medical rehabilitation research, health and functioning, and the ability to return to school or work where appropriate.

3. A shift in focus at NIDRR away from health and function research is unwise and seriously erodes our nation's ability to solve the important questions that confront people with disabilities in seeking to return to functional and fulfilling lives after the onset of a disabling condition.

4. NIDRR should continue and re-emphasize the importance in its funding priorities of health and function research, including medical rehab research.

Brain Injury Legislative Update

Good news from the Brain Injury Association of America regarding the Traumatic Brain Injury Act:

The full House Energy and Commerce Committee passed H.R. 1418, legislation to reauthorize the Traumatic Brain Injury Act. 

Earlier this week, the Energy and Commerce Committee's Subcommittee on Health approved the Traumatic Brain Injury Act of 2008 and forwarded it on for consideration by the full Committee.  Now that the full Committee has passed the bill, the legislation is expected to be brought up on suspension for consideration on the House floor when Congress reconvenes after a two-week recess, which will begin on Monday.

The Brain Injury Association of America (BIAA) wishes to thank Rep. Pascrell, Rep. Platts, as well as Rep. Pallone and Chairman Dingell, for swiftly moving this bill forward.  In addition, BIAA enthusiastically thanks all of its grassroots advocates for both longstanding and recent efforts to support timely reauthorization of the TBI Act! This is a very positive development towards the goal of getting the TBI Act reauthorized before the end of this year, and a very exciting development for Brain Injury Awareness Month!

Brain Injury Association of America Legislative Update

Laura Schiebelhut, Brain Injury Association of America, Public Affairs Manager has requested that I circulate the following legislative update

Dear Advocates:

This week was an eventful one on Capitol Hill, including a long-awaited breakthrough on legislation to reauthorize the TBI Act.

On Wednesday, March 5, the House Committee on Energy and Commerce Health Subcommittee announced its plans to markup the Reauthorization of the Traumatic Brain Injury Act (H.R. 1418) the following day, on Thursday, March 6.  Although the markup session was ultimately stalled (see below for more information), this development still marks very positive progress towards the goal of getting the TBI Act reauthorized before the end of this year, a leading BIAA policy priority. 

Also this week, the House of Representatives passed H.R. 1424, mental health parity legislation sponsored by Rep. Patrick Kennedy (D-RI) which would require health insurers to offer mental health benefits equal in cost and scope to medical and surgical benefits.  BIAA issued an enthusiastic letter of endorsement for the bill shortly before it was considered on the House floor. 
Looking ahead to next week, the fiscal 2009 budget resolutions are expected to be the focal point of legislative activity in both the House and Senate, as both chambers will consider their respective budget plans before adjourning for the two-week spring recess which begins on March 17.  Of course, next week will also include multiple TBI advocacy and awareness activities on Wednesday, March 12, as part of Brain Injury Awareness Day on Capitol Hill.

I will be on Capital Hill on March 12th in connection with Brain Injury Awareness Day and hope to see many of my friends and colleagues.

Urge the Senate to Pass a Tough Consumer Law

Right now, the Senate is considering a bill, the Consumer Product Safety Reform Act of 2007 (S. 2663), that would give the Consumer Product Safety Commission much-needed muscle. Please urge your senators to vote for the bill and any strengthening amendments  and to oppose industry's proposals to weaken the bill. For more on consumer product safety, visit the Public Citizen web site. An editorial supporting this legislation was published in today's New York Times.

News Alert from Brain Injury Association of America

The Brain Injury Association of America has just received word that the House Energy and Commerce Subcommittee on Health plans to markup the Reauthorization of the Traumatic Brain Injury Act (H.R. 1418) this Thursday, March 6, 2008, at 10 a.m. in Room 2123 of the Rayburn House Office Building.

This is a very positive development towards the goal of getting the TBI Act reauthorized before the end of this year, and a very exciting development for Brain Injury Awareness Month!

Brain Injury Awareness Day on Capital Hill: March 12, 2008

The Congressional Brain Injury Task Force is hosting a "2008 Brain Injury Awareness Day," on Capitol Hill, March 12, 2008.

Multiple events are planned during the day which are designed to educate Members of Congress and their staff about brain injury. These events include an Awareness Day Fair, which will feature exhibits and informational materials from individuals and organizations working in the field of brain injury.

The day will also include a Congressional Briefing focused on the topic of "Traumatic Brain Injury and Community Needs." The end of the day will feature an early-evening Congressional Reception sponsored by various national advocacy organizations, including the National Brain Injury Treatment and Training Foundation (NBIRTT), the Brain Injury Association of America (BIAA), the National Disability Rights Network (NDRN) and the National Association of State Head Injury Administrators (NASHIA).

The Brain Injury Association of America urges all advocates to attend "2008 Brain Injury Awareness Day" events, and help educate Members of Congress and their staff. The Day also represents an important opportunity to network with others interested in helping increase brain injury awareness.

2008 Brain Injury Awareness Day Schedule of Events:

Brain Injury Awareness Fair 10:00 a.m. – 2:00 p.m. First Floor Foyer of the Rayburn House Office Building

Congressional Briefing on “Traumatic Brain Injury and Community Needs” 3:00 p.m. – 4:00 p.m. 1116 Longworth House Office Building

Congressional Reception Celebrating Brain Injury Awareness Day 5:00 p.m. – 6:30 p.m. 2105 Rayburn House Office Building

Please RSVP by Monday, March 3, 2008, to Hope Mandel in Congressman Bill Pascrell's office if you wish to attend and/or exhibit materials during the Awareness Fair. You may also contact Hope at (202) 225-5751 or Becky Wolfkiel in Congressman Platts' office at (202) 225-5836 with questions or for more information. In addition, as always, you may contact Laura Schiebelhut, BIAA's Director of Government Affairs, or 703-761-0750 ext. 637, for further clarification.

A CDC Review of School Laws and Policies Concerning Child and Adolescent Health

Traumatic brain injury (TBI) has a significant impact on the ability of children to obtain a quality education. Unfortunately, not all children receive the education that they are entitled to because of the inability of parents to access services under Individuals with Disabilities Education Improvement Act (IDEA). In other instances schools lack specific policies related to educational issues surrounding a TBI.

Education and public health leaders can use specific laws and policies to promote programs and strategies that foster an environment in which children and adolescents can thrive and learn.

The Centers for Disease Control and Prevention’s (CDC) Division of Adolescent and School Health and Public Health Law Program engaged legal scholars and researchers at the Centers for Law and the Public’s Health: A Collaborative at Johns Hopkins and Georgetown Universities to review the use of law as a tool for improving and protecting the health and safety of children, adolescents, and staff in public elementary and secondary schools.

The culmination of the project is the report “A CDC Review of School Laws and Policies Concerning Child and Adolescent Health.” Using a Coordinated School Health Program model as a framework, the report gives educators and public health professionals new access to information on laws and policies important to the health of children and adolescents in schools. It is intended to help practitioners and policymakers in public health and education at the Federal, State, and local levels enhance their knowledge of relevant laws and policies. The full report was published in the February 2008 issue of the Journal of School Health and is available for download from the American School Health Association website by clicking here.

New York State Traumatic Brain Injury Services Coordinating Council: Next Meeting

The next meeting of the New York State Traumatic Brain Injury Services Coordinating Council which I am honored to chair will take place in New York City on March 28, 2008 from 10:30 AM - 3:00 P.M. at the offices of the  New York State Department of Health, 90 Church Street, New York, NY  4th Floor Conference Room.

The Council is charged with recommending to the Department of Health, long range objectives, goals and priorities as well as providing advice on planning, coordination and development of needed services.

Since becoming Chair of the Council, it has been my goal to increase public participation in the work of the Council and provide meaningful recommendations and assistance to the Health Department.  At our last meeting, I formed new committees to look at various aspects of traumatic brain injury in New York State and formulate specific proposals that can be forwarded to the Commissioner of Health.  Since that meeting each of the committees has met and formulated an agenda which will be presented at this upcoming meeting.

The council will also hear reports from various state agencies on their TBI programs.

Additionally, at this meeting we will hear a presentation on Traumatic Brain Injury and Substance Abuse Issues and will discuss recommendations that can be made to improve services in this area.

It is important to note that due to security, anyone who wishes to attend MUST contact Dawn Crary to register.  If you are not registered in advance, then you will not be allowed access to the building.

Here is the tentative agenda for our March 28th meeting:

10:30am – 10:35am Welcome and Review and Approval of Minutes from the December 12, 2007 Council Meeting

10:35am – 11:00am TBI Waiver Program Update
                             Pat Greene-Gumson, NYS Department of Health, Office of Long Term Care

11:00am – 11:45am Presentation: Traumatic Brain Injury and Substance Abuse Issues
                              Ed Ross, International Center for the Disabled
                              Tamara Miller-Kammerer, OASAS, Blaisdell Addiction Treatment Center 
   
11:45am – 12:45pm Group Discussion re: Presentation

12:45pm – 1:15pm Lunch

1:15pm – 1:45pm State Agency Reports

1:45pm – 2:15pm Subcommittee Reports

2:15pm – 2:45pm Public Comment Session
   
2:45pm – 3:00pm Summary/Next Steps/Adjournment

Legislative Update From Brain Injury Association of America

The Brain Injury Association of America has requested that I publish the following legislative update on traumatic brain injury issues pending in Congress:

Dear Advocates:

Congress held numerous budget and appropriations hearings this week, as well as several hearings addressing health care provided to wounded service members and veterans.

The House Appropriations Subcommittee on Labor, Health and Human Services, and Education (Labor-HHS-Ed) held a hearing on Thursday on this year’s proposed budget for the Department of Health and Human Services, featuring HHS Secretary Michael Leavitt as a witness.  At the same time, BIAA signed on this week to a coalition letter to the Subcommittee urging its Members to provide $30 million for TBI Act programs this year.

Also this week, both chambers of Congress held important hearings on efforts to improve health care for returning service members, as well as to improve the veterans’ disability benefits system.  BIAA submitted questions and comments in relation to several of the hearings.

A significant victory in Medicaid policy was achieved late this week as well, as a Senate Amendment to prevent implementation of the Administration’s proposed regulation restricting reimbursement for Medicaid Targeted Case Management (TCM) was successfully added to an Indian health bill.  The Amendment would establish a Moratorium on implementation of the TCM interim rule until April 1, 2009.

Congress is in recess next week so further updates will be provided when Congress returns.

In the interim, please write to President Bush and your congressional representatives to restore full Traumatic Brain Injury Act funding in next year's budget.

Senators Clinton and Mikulski Protest Zero Funding for Traumatic Brain Injury Programs

Earlier this week I reported on the failure on the part of president Bush to seek funding for the federal Traumatic Brain Injury Program in his latest budget submitted to Congress. What follows is the correspondence sent by Senators Clinton and Mikulski to president Bush in protest.

February 12, 2008

The Honorable George W. Bush
The White House
Washington, D.C. 20500

Dear Mr. President:

During this time of war, we were deeply troubled to learn of your plan to eliminate the Traumatic Brain Injury (TBI) program administered by the Health Resources and Services Administration. As co-sponsors of legislation to improve the assessment, detection and treatment of TBI, as well as to expand support systems for members and former members of the Armed Services with TBI and their families, we are deeply concerned by the potential elimination of this program for all individuals affected by TBI. The TBI Program serves as a critical component of our efforts to address TBI across the country, and is an essential complement to our services for the significant number of servicemen and women returning from combat with TBI. We urge you to work with us, and other concerned members of Congress, to ensure full funding for the TBI Program in the HHS budget for Fiscal Year 2009.

Current estimates state that at least 5.3 million Americans have a long-term or lifelong need for help to perform activities of daily living as a result of TBI, with 1.4 million Americans sustaining a traumatic brain injury each year. An extremely complex injury, TBI encompasses a broad range of symptoms and disabilities, creating severe strain on the individual and his or her family. Depending on the part of the brain affected and the extent of the damage, individuals with brain injuries vary greatly in their level of need, requiring access to a broad array of services.

Recognizing the large number of individuals and families struggling to access appropriate and community-based services for TBI, Congress authorized the Federal TBI Program in the TBI Act of 1996. The program assists states in operating coordinated services for individuals with TBI and their families, encouraging the replication of best practices, and improving state service delivery systems. Two-year planning grants allow states to build infrastructure, three-year implementation grants permit states to improve access to services, and additional implementation partnership grants allow increased flexibility to meet state needs to address TBI. Currently, 47 states receive TBI grants.

In addition to the acute medical needs of individuals suffering from TBI, families also have to address the social and emotional issues that come with diminished mental capacity. The nature of the disease has also changed over time; the needs of returning soldiers suffering from TBI present new strains on state service delivery systems. Now more than ever, we must provide states with the funding and support to provide effective, person-centered services to support individuals and their families. To cut funding now will jeopardize the ability of our health care system to address the needs of all Americans impacted by TBI. We urge you to reconsider this shortsighted decision, and join us in our efforts to restore full funding to the TBI program.

Sincerely,

Hillary Rodham Clinton

Barbara Mikulski

I urge all my readers to lend their voice to the calls to restore funding to the TBI programs.  Please write and call the White House and your congressional representatives as soon as possible.

Has the Senate Forgot About The Way The NFL Handles Traumatic Brain Injury Claims?

The Senate Judiciary Committee in addition to examining the destruction of tapes by the NFL, needs to look at how the NFL and their disability fund handles claims of traumatic brain injury.

I am hopeful that the Senate committee and Senator Specter who has been getting a good deal of attention on his questioning of Commissioner Goodell on the missing tapes, spend as much time on looking at the issues of why brain injured players are not receiving the compensation they so justly deserve.  Senator Spector is quoted as saying, "We have the right to have honest football games."  We also have the right to have an honest assessment of a player's disability.

The committee needs to address the deference under ERISA laws that courts give to the paid experts for hire retained by the league to defeat the claims of players.  Despite overwhelming evidence of permanent traumatic brain injury, the league is permitted to seek paid experts to offer opinions that are flawed and based upon antiquated science.  Yet, because of the way ERISA is written, the league is given "unfettered discretion" to rely upon any expert of their choice.

This law and its interpretation defies principles of due process and needs to be changed to protect players and all injured workers.

Criticism of Proposed New Rules on Classifying Brain Damage

Formal comments criticizing regulations proposed by the Department of Veterans Affairs governing compensation of veterans with traumatic brain injury has been submitted by U.S. Sen. Daniel K. Akaka (D-HI), Chairman of the Veterans' Affairs Committee who was joined by Senators Rockfeller, Murray, Obama, Tester, Brown, and Sanders.

"The new rules must provide for a fair evaluation of the veteran's disabilities. Unfortunately, the proposed regulations do not," said Sen. Akaka.

Under current regulations, compensation for symptoms attributable to TBI, such as headaches, dizziness, or insomnia is limited to "10 percent and no more." While VA recognizes that this requirement is outdated, it remains in effect pending the release of new rules. Chairman Akaka and majority members asked that this outdated rule be withdrawn immediately.

Akaka also objected to a section of the proposed rule which would not consider the severity or frequency of TBI symptoms, only count the number of symptoms.

The proposed brain injury regulations and the formal comment letter sent by Chairman Akaka and majority members can be found  by clicking here .

Brain Injury Association of America Condemns President's Budget Requests

The Brain Injury Association of America has requested that I circulate the following press release concerning the proposed elimination of the Federal Traumatic Brain Injury (TBI) Program in President Bush's budget submission to Congress:

Brain Injury Association of America Condemns President’s Fiscal 2009 Budget

(Washington, D.C.) – For the third year in a row, The White House has proposed the complete elimination of the Health Resources and Services Administration (HRSA) Federal TBI Program, which provides grants to state agencies and protection and advocacy organizations to improve access to health and other services for individuals with traumatic brain injury (TBI) and their families. 

Increasingly, national policymakers and the American public are coming to understand the dramatic implications of TBI on active duty service members, veterans and civilians alike.  In his State of the Union speech last week, President Bush pledged his dedication to meeting the health care needs “of a new war and a new generation.”

“As more service members and veterans join the 1.4 million civilian children and adults who sustain TBIs in the U.S. each year, the lack of priority given to TBI in the President’s budget is deeply disappointing,” said Susan Connors, president and CEO of the Brain Injury Association of America (BIAA), adding, “President Bush just doesn’t get it.”

“My family’s experience demonstrates the interdependence of military and civilian systems of care,” said Dave Woodruff, a member of the BIAA Board of Directors whose brother, ABC anchor Bob Woodruff suffered a severe TBI while covering the war in Iraq.  The Federal TBI Program supports coordination among state government agencies and public and private organizations to improve TBI care from trauma to community re-integration.  Most military and civilian patients end up living in the community where a complex maze of service systems, if it exists, must be coordinated.

BIAA will work vigorously to restore funding for HRSA's TBI Program, joining with coalition partners at the national level and calling on the highly effective Congressional Brain Injury Task Force to educate their colleagues in Congress and The White House on the need for and value of the Federal TBI Program.

Can A Monitor Prevent Brain Damage During Surgery?

An interesting article appeared in USA Today concerning a monitor that can determine oxygen saturation in the brain during surgery. 

Although this monitor has been in existence for over ten years, it still faces resistance from some doctors who still question it usefulness.

In the past I have represented individuals who have sustained anoxic brain damage during surgery as a result of poor anesthesia techniques and poor monitoring of a patient's blood pressure.  Any device that will warn physicians when the brain is not receiving sufficient quantities of oxygen is a welcome addition to efforts to improve patient safety.

The device discussed in the article will detect subtle changes in the amount of oxygen reaching the brain and cause increases in blood pressure and blood flow to the brain so that sufficient oxygen reaches it.  The brain is extremely sensitive to oxygen deprivation.  After only a few minutes without sufficient supplies of oxygen, brain damage will start to occur.

You can read the full story by clicking here.

Brain Injury--Legislative Update

The following legislative update has been provided by the Brain Injury Association of America

Update on FY2008 Defense Authorization Bill Status

House Democratic leaders have scheduled an override vote on President Bush’s recent veto of the National Defense Authorization Act for Fiscal Year 2008 (H.R. 1585) to take place when the House of Representatives returns to session on Tuesday, January 15.

Late last month, President Bush unexpectedly vetoed the defense authorization bill over provisions in the bill that would allow plaintiffs in the United States to sue foreign governments, including Iraq.

Congressional passage of this bill in December represented a major legislative victory for improving TBI care for returning service members and veterans.  BIAA lobbied actively this past year on many of the TBI care provisions included in the bill and grassroots activity on the part of BIAA advocates, as well as support from the Congressional Brain Injury Task Force, helped ensure that these TBI provisions were included in the final bill.

There is a good chance that the override vote scheduled to occur on Tuesday will fail in the face of unified Republican opposition.  If this occurs, it seems likely that Democratic leaders would then bring a new bill directly to the House floor that would closely resemble the vetoed defense bill, but with a fix that is currently being negotiated.  Similar Senate action seems likely to follow. 

According to an article published in CQ Today earlier this week, “While leaders of the Armed Services committees are taking the lead in the substantive negotiations, a new defense bill likely would go straight to the House and Senate floors to minimize opportunities for members to amend the measure.”

The widespread hope is that this new, slightly revised defense authorization bill will be signed into law before the end of January.

BIAA continues to hold off on organizing grassroots activity at this time, pending further legislative developments this week and next.

President Bush To Release Contingency Funds for Veterans

The White House announced this week that President Bush plans to approve $3.7 billion in "contingency” funding for veterans’ health programs sometime next week.

This welcome development marks the end of speculation over whether the president would block release of the funding, which was included as “emergency” funding in the FY2008 omnibus appropriations bill which passed last month.

During end-of-the-year appropriations negotiations in December, Congressional leaders designated this $3.7 billion in spending as “emergency” funding in order to keep it from counting against discretionary spending caps.  This left the ultimate decision on whether to release the funding up to President Bush.

Veterans groups and Democrats have been advocating for the release of this additional funding, which the president has until Jan. 18 to approve.

According to a Dec. 21 letter from Senate Veterans’ Affairs Committee Democrats, this funding “will ensure, among other things, that the Department will be able to provide timely access to services, furnish improved mental health services and develop the needed capacity to handle the massive claims backlog.”

Note: The House of Representatives returns from recess this Tuesday, January 15; the Senate reconvenes next Tuesday, January 22.

Brain Injury Legislative Update

I have been requested to distribute the following update on federal traumatic brain injury funding by the Brain Injury Association of America:

As you will unfortunately read, although there has been a lot of talk in Congress about the need to dramatically increase appropriations for traumatic brain injury, the final bill failed to include the increases requested and advocated by the Brain Injury Association of America and in many cases failed to even maintain funding at last year's level. 

Traumatic brain injury is a national health crisis.  The failure on the part of Congress to make appropriate appropriations for brain injury is unforgivable.  The Brain Injury Association of America should be thanked for all of their efforts.  Although understaffed and underfunded, they have worked long and hard for those with brain injury and their families.  The failure to appropriate necessary funding is certainly not the fault of the association. 

"Last night, Democratic leaders in Congress filed a massive omnibus appropriations bill (H.R. 2764) that largely matches President Bush’s proposed spending limit of $933 billion for all Fiscal Year (FY) 2008 appropriations.  The omnibus spending bill combines the 11 remaining FY2008 appropriations bills not yet enacted into law this year.

Note: Although the Fiscal Year 2008 Labor-HHS-Education spending bill (H.R. 3043) was passed by Congress earlier this fall, it was subsequently vetoed by President Bush, and thus has now been included in the omnibus appropriations bill.

Unfortunately, the Labor-HHS-Education spending included in this week’s omnibus appropriations bill includes $145.1 billion in discretionary spending, which represents about $5.6 billion less discretionary funding than was included in H.R. 3043.   Overall discretionary funding in the Labor-HHS-Education section of the omnibus bill includes about $600 million more than was provided through last year’s Labor-HHS-Education bill.

TBI programs, unfortunately, were among those losing discretionary funding compared to the amounts contained in H.R. 3043.  While H.R. 3043 would have increased funding for the HRSA TBI Program from last year’s total of $8.910 million to $9.455 million, this week’s omnibus bill would instead reduce funding for this program to $8.754 million. 

Despite this inexplicable and unacceptable decrease in funding for the HRSA TBI program, this week’s omnibus bill nevertheless contains a few heartening funding increases for other TBI programs.  CDC TBI-related activities would receive an increase of approximately $500,000 over last year. In addition, the TBI Model Systems of Care program received a boost of approximately $800,000 over last year’s funding amounts, with specific legislative language directing that the funding increase be used to fund two additional TBI research centers.

The outlook for final passage of this omnibus appropriations bill by the end of the week has been deemed likely, although not assured.  Republicans are currently reviewing the bill, and it is anticipated that the Senate will add Iraq War supplemental funding when the bill reaches the Senate floor.

Democrat leaders in Congress have asserted that although undesirable, the funding cuts contained in this week’s appropriations omnibus appropriations bill are still preferable to the President’s budget blueprint (which would have eliminated all funding for HRSA TBI Act programs).  Although the funding level for the HRSA TBI program contained in this omnibus bill is extremely disappointing and unacceptable, strong TBI advocacy efforts this year undoubtedly produced a more positive outcome than would have resulted if the voices of TBI advocates were not heard.  We will continue to fight to ensure that these voices are heard, louder than ever, next year.

OMNIBUS APPROPRIATIONS BILL (H.R. 2764) FUNDING NUMBERS IN BOLD

CDC TBI Programs (HHS):  $5.811 million

-H.R. 3043 (Labor-HHS-Education appropriations bill passed earlier this year by Congress but vetoed by President Bush): $5.960 million

-Last Year (Fiscal Year 2007):  approx. $5.3 million

HRSA TBI Programs (HHS) (TBI State Grant Program and Protection and Advocacy Systems):  $8.754 million 
-H.R. 3043:  $9.455 million

-Last Year:  $8.910 million

TBI Model Systems of Care (NIDDR/Department of Education):  $8.3 million, with specific conference report language included in the final bill as follows:“The amended bill specifies $8,300,000 within the National Institute on Disability and Rehabilitation Research to carry out the traumatic brain injury model systems of care program and to fund two additional centers that submitted applications for the last grant competition.” 
-H.R. 3043:  $8.4 million

-Last Year:  $7.5 million

Traumatic Brain Injury (TBI) Reauthorization Act Needs Your Help

On Tuesday night, December 11, 2007, the Senate passed legislation to reauthorize the TBI Act (S. 793)  by voice vote.   The fate of TBI Act reauthorization is now up to the House of Representatives.  Since authority for the TBI Act officially lapsed in 2005, it is essential that advocates encourage the House to take the bill up and pass it as soon as possible.  It is essential that you contact your  Representative to ensure swift House consideration and passage of the TBI Act.

Legislative Update from Brain Injury Association of America

The following is a legilstaive update provided by the Brain Injury Association of America:
 
SENATE PASSES TBI ACT REAUTHORIZATION BILL

Earlier today (Tuesday, December 11, 2007), the Senate passed by voice vote S. 793, legislation to reauthorize the TBI Act.  The reauthorization includes provisions to continue and hopefully expand TBI Act programs, such as the HRSA State Grant and CDC surveillance programs. 

This is a big victory, as the authorization for TBI Act programs officially lapsed in 2005 and advocacy efforts to renew this authority have been vigorous.  Stay tuned to BIAA for further information and analysis as developments progress.

APPROPRIATIONS HANG-UP

Unfortunately, as of press time on Tuesday, December 11, 2007, Congressional leadership had still not made a final decision regarding floor consideration of a “split-the-difference” omnibus appropriations bill, and thus, a conference report for this bill has not been filed.  Stay tuned to BIAA for the latest updates on this situation.

DEFENSE AUTHORIZATION BILL – INCLUDING TBI CARE PROVISIONS  - SET FOR PASSAGE

Congress is expected to pass the National Defense Authorization Act for Fiscal Year 2008 - including key wounded warrior provisions related to TBI care - this week.  The House of Representatives is expected to adopt the conference report tomorrow (Wednesday) or Thursday, followed by predicted swift passage in the Senate.

According to CQ Today (Dec. 11, 2007), “Several dozen House members might vote against the bill because of its war authorization, but they are likely to prove only a bump in an otherwise smooth road to adoption. And despite the conferees’ differences with the White House on a wide range of issues including military pay and overseeing contractors, they have sufficiently modified provisions to avert a veto threatened by the administration, members and aides predict.”

BIAA has lobbied actively this year on many of the TBI care provisions contained in the final version of the bill, and grassroots activity on the part of TBI advocates helped ensure that these TBI provisions were included in the conference report.

Below is a summary of the key TBI provisions included in the bill:

Major TBI Provisions in the National Defense Authorization Act for Fiscal Year 2008 (H.R. 1585)

Overlap of DoD/VA benefits:  Allows severely ill or injured service members and veterans to access their health care - including TBI care - based on their medical condition, rather than on their status as active duty or medically retired.  For example, if implemented, this overlap of benefits would allow medically retired veterans to access TBI care at private/civilian facilities that are eligible TRICARE providers.  Currently, this access is limited to service members who have active duty status. Note: Some civilian TRICARE facilities provide cognitive rehabilitation therapy.  This provisions sunsets in 2012. (Sec. 1631)

DoD Comprehensive Plan To Address TBI: Requires DoD to submit within 180 days of enactment, in consultation with the VA, a comprehensive plan for programs and activities of the Department of Defense to prevent, diagnose, mitigate, treat, research and otherwise respond to TBI and PTSD.  Plans are directed to include provisions for making injured service members aware of options for different treatments. (Sec. 1618)

This plan is required to include a proposal for the development and deployment of evidence-based means of assessing traumatic brain injury, PTSD, and other mental health conditions in members of the Armed Forces, including a system of pre-deployment and post-deployment screenings of cognitive ability in members for the detection of cognitive impairment.  (Sec. 1618)

This plan is also required to include a proposal on the development and deployment of an education and awareness training initiative designed to reduce the negative stigma associated with TBI and PTSD, and a plan for the provisions of education and outreach to families of members of the Armed Forces with TBI, PTSD, or other mental health conditions. (Sec. 1618)

VA Individualized TBI Rehabilitation Plans/Use of Civilian Facilities for TBI Care: Requires the VA Secretary to develop an individualized plan for rehabilitation and reintegration into the community for each veteran or service member who receives inpatient or outpatient care at the VA for TBI (Sec. 1702).

Note:  Unfortunately, the final version of this defense authorization bill/conference report does NOT include the provision in the Senate version of the bill which would have required the Secretary of the VA to provide care in non-VA (civilian) facilities if the Secretary determines that the VA is unable to provide care at the frequency or duration prescribed in the individualized plan, for rehabilitation and reintegration, or if the Secretary determines it is optimal for the veteran to receive care in a non-VA facility. 

Similar – but weaker - language, was included, stating that, in implementing and carrying out the individualized plans, the Secretary of the VA “may provide hospital care and medical services through cooperative agreements with appropriate public or private entities that have established long-term neurobehavioral rehabilitation and recovery programs.” (Sec. 1703)

Procedures for Referrals to VA and Civilian Health Care Services: Requires a comprehensive policy on improvements to care, management, and transition of recovering service members to “provide for uniform policies, procedures, and criteria among the military departments on the referral of recovering service members to the Department of Veterans Affairs and other private and public entities (including universities and rehabilitation hospitals, centers, and clinics) in order to secure the most appropriate care for recovering service members, which policies, procedures, and criteria shall take into account, but not be limited to, the medical needs of recovering service members and the geographic location of available necessary recovery care services.” (Sec. 1611)

DoD TBI Center of Excellence: Requires the establishment of a Center of Excellence in the Prevention, Diagnosis, Mitigation, Treatment, and Rehabilitation of Traumatic Brain Injury, including mild, moderate, and severe TBI.  The Secretary of Defense is directed to enter into partnerships, to the maximum extent practicable, with the VA, institutions of higher education, and other appropriate public and private entities, to further the research efforts of the centers.   This DoD TBI Center of Excellence is responsible for implementing the DoD’s comprehensive plan to address TBI - as required by Sec. 1618 – once this plan is developed.  (Sec. 1621)

Collaboration Required in New VA TBI Research Efforts:  Requires new VA TBI research efforts to collaborate with facilities that conduct research on rehabilitation for individuals with TBI and receive grants for such research from the National Institute on Disability and Rehabilitation Research of the Department of Education (for example, the TBI Model Systems of Care program). (Sec. 1704) 

National Academy of Sciences DoD/VA TBI Study: Requires DoD, in consultation with the VA, to contract with the National Academy of Sciences to study the physical and mental health – specifically including the neurological, psychiatric, and psychological effects of TBI – of members and former members of the Armed Forces who are deployed in OEF or OIF, and their families as a result of such deployment.  Specifically, a comprehensive assessment is required - not later than three years after the date of legislative enactment – of “the full scope of the neurological, psychiatric, and psychological effects of traumatic brain injury on members of the Armed Forces, including the effects of such effects on the family members of such members and former members, and an assessment of the efficacy of current treatment approaches for traumatic brain injury in the United States and the efficacy of screenings and treatment approaches for traumatic brain injury within the Department of Defense and the Department of Veterans Affairs.  (Sec. 1661)

Comprehensive Long-Term TBI Rehabilitation Program in VA: Requires the Secretary of the VA to develop and carry out a comprehensive program of long-term care for post-acute traumatic brain injury rehabilitation that includes residential, community, and home-based components utilizing interdisciplinary treatment teams.  This program is to be developed and located in Department of VA polytrauma rehabilitation centers.  Eligibility is restricted to veterans diagnosed as suffering from “moderate to severe” traumatic brain injury (excludes mild) who are unable to manage routine activities of daily living without supervision or assistance, as determined by the Secretary. (Sec. 1702)

Pilot Program on Assisted Living Services for Veterans with TBI:  Requires the Secretary of the VA, in collaboration with the Defense and Veterans Brain Injury Center of the Department of Defense, to carry out a five-year pilot program to assess the effectiveness of providing assisted living services to eligible veterans with traumatic brain injury to enhance the rehabilitation, quality of life, and community integration of such veterans (Sec. 1705)

Report on TBI Classfications:  Requires the Secretary of Defense and the Secretary of Veterans Affairs to jointly submit a report – not later than 90 days after the date of legislative enactment - describing the changes undertaken within the Department of Defense and the Department of Veterans Affairs to ensure that traumatic brain injury victims receive a medical designation concomitant with their injury rather than a medical designation that assigns a generic classification (such as “organic psychiatric disorder.”) (Sec. 1664)

TBI Registry in VA:  Requires the Secretary of the VA to establish and maintain a registry of names of each individual who: 1) served as a member of the Armed Forces in Operation Enduring Freedom or Operation Iraqi Freedom; 2) exhibits symptoms association with TBI; 3) applies for care and services from the Department of Veterans Affairs or files a claim for compensation for disability associated with such service; and 4) grants permission to the Secretary to include such information in the registry. (Sec. 1704)

Brain Injury Association of America: Legislative Alert

Here is the latest legislative alert from the Brain Injury Association of America:

Dear Advocates:

Congress returned this week from Thanksgiving Break, and acted on several bills impacting traumatic brain injury care and programs.

Late last night, the conference report for the National Defense Authorization Act for Fiscal Year 2008 was filed, containing important Wounded Warrior provisions, including several related to TBI care for returning service members.

Also this week, Congress reportedly made progress on year-end spending negotiations, setting up a likely vote next week on an omnibus appropriations bill including reduced spending levels in an attempt to compromise with the White House.

In addition, an expected markup of an important Medicare package by the Senate Finance Committee was scrapped late this week in favor of direct negotiations with the House of Representatives.

Congress will attempt to resolve all of these issues – and more – before ending this year’s session within the next couple of weeks.

New York State Traumatic Brain Injury Services Coordinating Council: Meeting Annoucement

As the Chair of the State of New York Traumatic Brain Injury Services Coordinating Council, I am pleased to provide information and the agenda for our next meeting scheduled for Wednesday, December 12, 2007 at 10:00 AM at the offices of the New York State Department of Health located at 161 Delaware Avenue, Delmar, New York.

The agenda for this meeting is as follows:

• Report and update on the TBI Waiver Program
• New York State SPARCS Date Discussion regarding traumatic brain injury data collected by the Health Department
• Subcommittee Structure and Future Direction Discussions
• Public Comment Period

The Council was created by the New York State Legislature and is charged with recommending to the department of health long range objectives, goals and priorities concerning traumatic brain injury.  It is also charged with providing advice on the planning, coordination and development of needed traumatic brain injury services to the residents of New York State.

As the new chair of this council, I have carefully examined the past direction of the council and the progress that it has made in fulfilling its legislative mandate.  After discussions at our last meeting, I have created several new committees to be announced at the meeting.  In addition to membership by council members, I have also invited additional participation by individuals with demonstrated knowledge and expertise in traumatic brain injury to assist in evaluating TBI services in New York State.  I am hopeful that the newly formed committees will address the many needs of New York residents who have sustained a traumatic brain injury as well as the needs of their family members.

I welcome your participating at the next scheduled council meeting.

The High Costs of Health Care

Any one concerned about the rising costs of health care should read the editorial in today's New York Times, entitled, The High Cost of Health Care.

As the Times points out, the solutions are not easy but these costs are destroying families and placing unacceptable burdens upon society.  As a nation we must confront these issues and work toward a reasonable solution.  We cannot let big business or insurance companies control this debate.  We must make sure that quality care is delivered to all at reasonable prices.  A health care system that only works for the rich and for big business and insurance companies must be changed and changed now!

The implications of these high costs are most acute for those with a family member suffering with brain damage.  It is important that we join this debate and make our opinions heard.

Here is a sampling of the New York Times editorial:

"The relentless, decades-long rise in the cost of health care has left many Americans struggling to pay their medical bills. Workers complain that they cannot afford high premiums for health insurance. Patients forgo recommended care rather than pay the out-of-pocket costs. Employers are cutting back or eliminating health benefits, forcing millions more people into the ranks of the uninsured. And state and federal governments strain to meet the expanding costs of public programs like Medicaid and Medicare.

Health care costs are far higher in the United States than in any other advanced nation, whether measured in total dollars spent, as a percentage of the economy, or on a per capita basis. And health costs here have been rising significantly faster than the overall economy or personal incomes for more than 40 years, a trend that cannot continue forever.

It is the worst long-term fiscal crisis facing the nation, and it demands a solution, but finding one will not be easy or palatable.

Contrary to popular beliefs, this is not a problem driven mainly by the aging of the baby boom generation, or the high cost of prescription drugs, or medical malpractice litigation that spawns defensive medicine. Those issues often dominate political discourse, but they have played relatively minor roles in driving up medical spending in this country and abroad. The major causes are much more deep-seated and far harder to root out."

To read the full editorial and the solutions proposed by the Times, click here.