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The Virginia Acts of the Assembly, 2022 Special Session I, HB680 directed the Department of Medical Assistance Services (DMAS) to implement a new case management service for individuals with severe traumatic brain injury in the Medicaid program.  DMAS is pleased to announce that a new case management service designed to support members who have sustained a traumatic brain injury on or after the age of 18 will soon be available.

Brain Injury Services Case Management is designed to provide service coordination and person-centered planning with members who have sustained a traumatic brain injury.  Brain Injury Case Management Services are defined in a pending provider manual supplement that is currently posted for a second public comment period on the Virginia Regulatory Town Hall website HERE. This new provider manual supplement is scheduled to be finalized and published online by DMAS by September 30, 2023. Services delivery will begin after the manual is finalized.  Prospective providers may submit enrollment applications to the Medicaid Enterprise Solutions (MES) provider enrollment portal beginning on August 1, 2023.  For more information on how to enroll as a provider please refer to the MES portal HERE.

Brain Injury Services Case Management is not part of a Medicaid waiver or specifically affiliated with any set of existing DMAS service systems. 

“Case management” means a service that includes the following activities:

• Assessing and planning services
• Linking the individual to services and supports identified in the individual support plan; assisting the individual directly for the purpose of locating, developing, or obtaining needed services and resources.
• Coordinating services and service planning with other agencies and providers involved with the individual; enhancing community integration.
• Making collateral contacts to promote the implementation of the individual support plan and community integration.
• Monitoring the individual to assess ongoing progress and ensuring that authorized services are delivered; and
• Educating and counseling the individual, family or legal representative to guide them to develop supportive relationships that promote the individual support plan for the direct benefit of the individual.