Public Policy at the Federal Level

Public Policy at the Federal level
BIA-MA asks for your support on a number of issues at the federal level, please also contact your Senators and Representative to support the following items.

Fully Fund the TBI Model of Care 
The TBI Model Systems are a collection of 16 research centers located across the United States that conduct disability and rehabilitation research under grants administered by the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR) of the Administration for Community Living. The TBI Model Systems are the only source of non-proprietary longitudinal data on what happens to people with brain injury across the lifespan. They are a key source of evidence-based medicine and serve as a “proving ground” for future researchers. TBI Model Systems sites work closely with the Department of Veterans Affairs on research to improve the treatment of Veterans with brain injuries.
BIA-MA calls on Congress to:

• Increase funding in FY ‘21 for NIDILRR’s TBI Model Systems of Care program to add one new Collaborative Research Project.
• Over the next five years, the Congressional Brain Injury Task Force requests increased funding by $15 million to expand the TBI Model Systems program:
• Increase the number of multicenter TBI Model Systems Collaborative Research projects from one to three, each with an annual budget of $1 million;
• Increase the number of competitively funded centers from 16 to 18 while increasing the per-center support by $200,000; and
• Increase funding for the National Data and Statistical Center by $100,000 annually to allow all participants to be followed over their lifetime.
• Provide “line-item” status to the TBI Model Systems within the broader NIDILRR budget.

Increase TBI Act Funding 
In October 2015, the TBI State Grant Program Act, was transferred to the ACL Administration on Disabilities Independent Living Administration, and the Protection & Advocacy (P & A) Grant Program was moved to the ACL Administration on Intellectual and Developmental Disabilities.  Massachusetts is one of only 24 states that receive TBI State grants and all the P&A grants are severely underfunded.  
BIA-MA calls on Congress to:

• Appropriate $19 million to fund the Federal TBI Program to increase the number of state grants;
• Allocate $6 million total to the P&A Grant Program.

Fund CDC TBI Programs
The Traumatic Brain Injury (TBI) Act of 1996, as amended, authorizes the Centers for Disease Control and Prevention (CDC) for data collection, prevention, public education and research.  
BIA-MA calls on Congress to:

• Support CDC in its mandate to review the scientific evidence related to brain injury management in children and identify opportunities for research;
• Support TBI national surveillance; and
• Appropriate $10 million to fund CDC’s TBI programs.

Take a Stand to Protect Student Athletes from Concussions 
The Centers for Disease Control and Prevention (CDC) estimates as many as 3.8 million concussions related to sports and recreation occur each year. In far too many instances, high school athletes are returning to the field before their brains have an opportunity to heal from a previous concussion. A repeat concussion can slow recovery and increase the likelihood of having long-term challenges. Repeat concussions can result in second impact syndrome, which can lead to permanent brain damage and even death.
BIA-MA urges Congress to take these steps:
• Support the Concussion Awareness and Education Act sponsored by Rep. Joyce Beatty (D-Ohio) to implement recommendations of the Institute of Medicine in its report, “Sports-Related Concussions in Youth: Improving the Science, Changing the Culture.”
• Appropriate $5 million for the CDC to scale the National Concussion Surveillance System, which would provide nationally representative incidence estimates of all TBI, sports- and recreation-related TBI, and TBI-related disability as well as the ability to monitor trends over time, including at the state level. Authorization for funding was included in the Reauthorization of the Traumatic Brain Injury Act of 2018.

Train First Responders on TBI and PTSD
First responders should be trained on traumatic brain injury (TBI), acquired brain injury (ABI), and post-traumatic stress disorder (PTSD).  Individuals with TBI, ABI or PTSD may have symptoms from their injuries that make if difficult for them to understand and follow directions or communicate clearly with first responders.

• Support the Traumatic Brain Injury and Post-Traumatic Stress Disorder Law Enforcement Training Act sponsored by Reps. Bill Pascrell, Jr. (D-NJ) and Don Bacon (R-Neb.), which would direct the Attorney General to develop crisis intervention training tool for use by law enforcement officers and first responders related to interacting with persons with TBI, ABI and PTSD.
• Require that the training be made available as part of the Police Mental Health Collaboration Toolkit, which is a no-cost online training tool that provides resources for law enforcement agencies partnering with mental health providers to effectively respond to calls for service, improve outcomes for people with mental illness, and advance public safety.
• Authorize an additional $4 million per fiscal year for the Justice and Mental Health Collaboration Program to fund grants to develop and implement this training.

Ensure Patient-Centered Access to Rehabilitation
Individuals with brain injury rely on Medicare and Medicaid to access the rehabilitative services and devices needed to regain health, function, and independence.  Patients often face barrier to access to rehabilitative services and devices due to coverage restrictions.  Utilization management tools like prior authorization, restrictive or proprietary admission guidelines, and onerous regulatory requirements significantly limit access to care for individuals with brain injury.  Key steps to increase access to care include the following:

• Ensure that efforts to unify Medicare’s Post-Acute Care payment system do not negatively impact access for people with brain injury and other complex conditions.
• Oppose efforts to restrict access to rehabilitation therapy services in all settings of care.
• Revise the “three-hour rule” to expand access to all appropriate skilled therapies (Access to Inpatient Rehabilitation Therapy Act)
• Reform the use of prior authorization in Medicare Advantage (Improving Seniors’ Timely Access to Care Act) and reject the use of prior authorization of inpatient rehabilitation facilities.
• Reform managed care plans in Medicare, Medicaid and private insurance to ensure appropriate access to rehabilitation and habilitation services and devices.
• Maintain rehabilitation’s status as the standard of care for people with brain injury to achieve maximum recovery, full function, return to work and other life roles and independent living.

For more information about Advocacy at BIA-MA, contact Kelly Buttiglieri at 508-475-0032 or kbuttiglieri@biama.org