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Legislative Update from Brain Injury Association of America

The following is a legilstaive update provided by the Brain Injury Association of America:

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.


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.


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)



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