I
103D CONGRESS
1ST SESSION
H. R. 2427
To amend title XIX of the Social Security Act to provide for optional coverage
under State medicaid plans of case-management services for individuals
who sustain traumatic brain injuries, and for other purposes.
IN THE HOUSE OF REPRESENTATIVES
JUNE 15, 1993
Mr. WYDEN (for himself, Mrs. UNSOELD, and Mr. FRANK of Massachusetts)
introduced the following bill; which was referred to the Committee on
Energy and Commerce
A BILL
To amend title XIX of the Social Security Act to provide
for optional coverage under State medicaid plans of case-
management services for individuals who sustain trau-
matic brain injuries, and for other purposes.
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ‘‘Medicaid Brain Injury
Rehabilitation Act of 1993’’.
SEC. 2. MEDICAID COVERAGE OF CASE-MANAGEMENT
SERVICES FOR INDIVIDUALS WITH TRAU-
MATIC BRAIN INJURIES.
(a) IN GENERAL.—Section 1905(a) of the Social Se-
curity Act (42 U.S.C. 1396d(a)) is amended—
(1) by striking ‘‘and’’ at the end of paragraph
(21);
(2) by striking the period at the end of para-
graph (24) and inserting a semicolon;
(3) by redesignating paragraphs (22), (23), and
(24) as paragraphs (25), (22), and (23), respec-
tively, and by transferring and inserting paragraph
(25) after paragraph (23), as so redesignated; and
(4) by inserting after paragraph (23), as redes-
ignated, the following new paragraph:
‘‘(24) case-management services provided (in
accordance with section 1931) for individuals who
sustain traumatic brain injuries; and’’.
(b) CASE-MANAGEMENT SERVICES DESCRIBED.—
Title XIX of the Social Security Act (42 U.S.C. 1396 et
seq.) is amended by adding at the end the following new
section:
‘‘CASE-MANAGEMENT SERVICES FOR INDIVIDUALS WITH
TRAUMATIC BRAIN INJURIES
‘‘SEC. 1931. (a) IN GENERAL.—For purposes of sec-
tion 1905(a)(24), case-management services for individ-
uals who sustain traumatic brain injuries are services pro-
vided to an eligible individual (as described in subsection
(d)) through a State case-management program that
meets the requirements of subsection (b).
‘‘(b) REQUIREMENTS
FOR STATE CASE-MANAGE-
MENT PROGRAMS.—
‘‘(1) STATE COORDINATOR.—A State case-man-
agement program meets the requirements of this
subsection only if the State has designated a State
coordinator (in this section referred to as the ‘State
coordinator’) for traumatic brain injuries who—
‘‘(A) establishes policies, standards, and
procedures for providing services under this sec-
tion to eligible individuals,
‘‘(B) contracts with qualified agencies or
employs staff to provide services under this sec-
tion to eligible individuals,
‘‘(C) supervises and coordinates services
for eligible individuals,
‘‘(D) makes necessary reports to the Sec-
retary, and
‘‘(E) performs any other duties described
in this section.
‘‘(2) CASE-MANAGEMENT
SERVICES.—A State
case-management program meets the requirements
of this subsection only if the program provides or ar-
ranges for the provision of the following case-man-
agement services for eligible individuals:
‘‘(A) An initial assessment of—
‘‘(i) the individual’s need for case-
management services, and
‘‘(ii) if the individual is an appro-
priate candidate for receiving case-manage-
ment services, the individual’s need for
other services, with an emphasis on identi-
fying community-based services required to
prevent institutionalization or minimize the
need for residential rehabilitation.
‘‘(B) Preparation of a treatment plan for
each individual requiring case-management
services based on consultation with the individ-
ual (other than an individual who is comatose)
and any person named by the individual. Prepa-
ration of the plan shall be completed—
‘‘(i) as soon as possible after the indi-
vidual suffers the injury, but may be de-
layed (by one or more periods of no more
than 15 days each) based on a physician
certification that contains a brief expla-
nation of the reason for the delay and at-