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Medicaid Traumatic Brain Injury Memorandum of Understanding (MOU) Program

GENERAL INFORMATION

The Michigan Department of Health and Human Services (MDHHS) is committed to providing high quality services and supports to individuals who have experienced a brain injury. Brain Injury Services (BIS) provides necessary services and supports to individuals with qualifying brain injuries who, but for the provision of these services, would otherwise be served in an institutional setting. The program provides critical brain injury-specific rehabilitation and support in the post-acute injury period with the goal of assisting the individual in becoming capable of living in the most independent setting.

BRAIN INJURY SERVICES SCOPE AND PURPOSE

BIS focuses on specialized rehabilitation and supportive services required upon release from an acute care setting following a moderate or severe brain injury. A brain injury does not include damage to the brain resulting from neurodegenerative disorders such as Alzheimer's disease or dementia. These services are for beneficiaries who can benefit from the advanced level of rehabilitative therapies and other services offered. BIS can be obtained in either a transitional residential or outpatient setting. All providers for BIS must have appropriate accreditation, certifications, or specialized training in serving individuals with brain injuries. These BIS providers are contracted with MDHHS to provide services covered in this chapter. Transitional Residential services are limited to six months for each brain injury.

BENEFICIARY ELIGIBILITY

To be eligible for BIS, an individual must meet the following criteria:

  • Be Medicaid-eligible.
  • Have a qualifying brain injury that occurred within 15 months of application to the BIS program.
  • Be medically stable.
  • Be able to participate in appropriate therapies as indicated:
  • For beneficiaries using Transitional Residential services, at least 15 hours per week upon approval for BIS.
  • For beneficiaries receiving Outpatient services, at least nine (9) hours per week.
  • Be determined appropriate for 60 to 90 days of BIS as supported by a Physical Medicine and Rehabilitation (PMR) physician's order.
  • For beneficiaries using Transitional Residential services, the order must specify that the physician expects significant progress within the next 90 days to allow for community-based discharge.
  • In the absence of a PMR physician's order, a psychological consultation conducted by a qualified professional that substantiates the beneficiary's ability to interact with the therapy treatment team and the ability to participate in the required therapy levels will be accepted.

For information regarding Brain Injury Services, please call 517-241-1685 or 517-241-1680. You may also email MDHHS-MSA-BIS@michigan.gov.