What is an Acquired Brain Injury?
An acquired brain injury is brain damage caused by events after birth, rather than as part of a genetic or congenital disorder. These include strokes, brain illness and other brain injuries. They are not what are called degenerative brain conditions, such as Alzheimer’s or Parkinson’s disease.
Some of the effects that a brain injury can have include:
- Cognitive effects, which include memory problems, difficulty concentrating, poor planning and judgment skills, language difficulties, and a lack of problem solving skills
- Sensory effects, such as altered visual/spatial perception, sense of touch and hearing, or vision impairments
- Emotional effects, including being impulsive, risky behavior, depression/anxiety, aggression or paranoia
- Physical effects, including severe headaches, seizures, poor coordination and balance, slurred speech, and being unable to move
What Kind of Help is Available from HHS?
Texas Health and Human Services provides a variety of programs to help people who are recovering from a brain injury become independent.
Comprehensive Rehabilitation Services
This program is for people who have traumatic brain and/or spinal cord injuries. The goal is to ensure they can function independently in their home or community. Counselors and family members work with the person to identify rehabilitation goals and what services they need to support increased independence. Services may include:
- Inpatient comprehensive medical rehabilitation services (ICMRS)
- Outpatient rehabilitation services
- Post-acute rehabilitation services (PARS)
To learn how to start getting services, call 877-787-8999, select a language, and then select Option 3. You also may call Texas 2-1-1 and press option 1 to speak with a representative.
Long-term Care Services
People who need to have longer-term services or supports may be able to get them through programs for people who have a medical or physical disability. Most long-term care programs require that you have limited income and assets, that you show a need for services, and that you be a U.S. citizen or qualified legal alien who lives in Texas.
Services may include:
- Personal care, such as housekeeping, meal preparation or personal tasks such as bathing and dressing
- Medical supplies or equipment
- Rides to medical appointments
- A break for your caregiver, also called respite
To learn more, call 855-YES-ADRC (855-937-2372).
To find out about other services, such as Medicaid or the SNAP food program, call Texas 2-1-1 or visit yourtexasbenefits.com.
Is There Help Available Outside of HHS?
If you don’t qualify for HHS services, there still may be other ways to pay for your rehabilitation care.
If you have insurance from an employer, talk with them to see what they will cover. You may even have short- or long-term disability coverage that can help. In Texas, a health benefit plan must include coverage for treatment and services related to an acquired brain injury.
- Hospitalization is not required, and services may be provided in a facility other than a hospital, such as a post-acute rehabilitation hospital or an assisted living facility.
- Periodic re-evaluation is covered if the patient initially is unresponsive to treatment but becomes responsive at a later date.
- Separate lifetime limitations for acute and post-acute care are required so the benefit is available at both stages.
- Pre-authorization and utilization review employees must be trained to prevent inappropriate denial of coverage and to avoid confusion of medical benefits with mental health benefits.
- Physicians must conduct medical necessity reviews before a denial of services is issued.
- Requests for utilization review or appeals for an extension of coverage based on medical necessity require a response by phone within three business days.
Health insurance cannot exclude:
- Cognitive rehabilitation therapy – Services to address therapeutic cognitive activities, based on an assessment and understanding of the individual’s brain-behavioral deficits.
- Cognitive communication therapy – Services to address comprehension and expression, including understanding, reading, writing and verbal expression of information.
- Neurocognitive therapy and rehabilitation – Services to address informational processing and to facilitate the development of higher level cognitive abilities.
- Neurobehavioral testing and treatment – An evaluation of the history of neurological and psychiatric difficulty, current symptoms, current mental status and the patient’s history, including the identification of problem behavior and interventions that focus on behavior.
- Testing and treatment – An evaluation of the functions of the nervous system and interventions that focus on the functions of the nervous system.
- Neurophysiological testing and treatment – Comprehensive tests to evaluate neurocognitive, behavioral and emotional strengths and weaknesses and interventions designed to improve or minimize deficits in behavioral and cognitive processes.
- Psychophysiological testing and treatment – An evaluation of the interrelationships between the nervous system and other bodily organs and behavior and interventions designed to alleviate or decrease abnormal physiological responses of the nervous system due to behavioral or emotional factors.
- Neurofeedback therapy – Services that use operant conditioning learning procedure based on electroencephalography (EEG) parameters and which are designed to improve mental performance and behavior and stabilize mood.
- Remediation – The process of restoring or improving a specific function.
- Post-acute transition services – Services that facilitate the continuum of care through rehabilitation and community reintegration.
- Community reintegration services – Services that facilitate the continuum of care as an affected individual transitions into the community.
Texas Insurance Code
The Texas Insurance Code (TIC) and the Texas Administrative Code (TAC) include information about health plan benefits (TIC Chapter 1352 and TAC Title 28, Chapter 21). To learn more, call the Texas Department of Insurance at 800-252-3439.
Small employer health benefit plans are not required to provide periodic re-evaluation, separate lifetime limitations for acute and post-acute care, or respond by phone within 3 days to requests for utilization review or appeals for an extension of coverage based on medical necessity.
Self-funded plans are not required to provide coverage for acquired brain injury.
There may be limits to health insurance coverage. A health benefit plan, other than a small employer health plan, must include the same payment limitations, deductibles, copayments and coinsurance factors for coverage required under this chapter as applicable to other similar coverage provided under the health benefit plan. Coverage under a small employer health benefit plan may be subject to deductibles, copayments, coinsurance, or annual or maximum payment limits that are consistent with the deductibles, copayments, coinsurance, or annual or maximum payment limits applicable to other similar coverage provided under the small employer health benefit plan.
Long-term care insurance
Some people have long-term care insurance which may help cover some of the cost. You can learn more at Own Your Future.
Supplemental Security Income
This federal program pays monthly benefits to people with limited income and resources who have a disability, who are blind or age 65 or older. You can learn more from the Social Security Administration.
Where can I Learn More?
- The Centers for Disease Control and Prevention website includes prevention tips, publications, research information, and other resources.
- BrainLine is a national multimedia project offering information and resources about preventing, treating, and living with brain injury. It is funded by the Defense and Veterans Brain Injury Center.
- 2-1-1 Texas provides information about state and local human services resources, including food, housing, utility assistance, counseling and other services.