New Jersey Statutes Title 30. Institutions and Agencies 30 § 4D-7jj

a. An acquired brain injury is an injury caused by an event, either internal or external to the injured individual, and does not include congenital or degenerative disorders, or those injuries induced by birth trauma. An acquired brain injury can either be categorized as a traumatic brain injury or non-traumatic brain injury. A traumatic brain injury is an alteration in brain function caused by an external force and may be caused by falls, assaults, motor vehicle accidents, or sports injuries. A non-traumatic brain injury is damage to the brain caused by internal factors, such as stroke, aneurysm, tumor, infectious disease, or anoxia.

b. A severe acquired brain injury can produce an altered or diminished state of consciousness and result in an impairment of cognitive abilities or physical functioning. It can also effect behavioral or emotional functioning. These impairments may be permanent and cause partial or total functional disability, leading to the injured individual requiring long-term care supports.

c. The State's Medicaid program provides brain injury services under the Managed Long-Term Supports and Services program, with the goal of providing community alternatives for individuals with brain injuries residing in nursing facilities or who are in the community and at risk for placement in nursing facilities.

d. Unlike other Medicaid community-based services, reimbursement rates for brain injury services have remained static in recent years despite growing costs, which threatens the ability of providers to meet the complex health needs of individuals with brain injuries and provide services within a safe and fulfilling community environment.

e. Despite the similar model of care, reimbursement rates for services provided to Medicaid beneficiaries with intellectual and developmental disabilities have not only increased, but have been restructured to account for adequate consideration for acuity, increased minimum wage requirements, and other inflationary trends that assert pressure on providers' cost structures.

f. By failing to receive reimbursement rates that adequately support services, brain injury providers are being forced to return this fragile population to more costly institutional care in nursing home facilities.

g. It is imperative that the Legislature take action and increase Medicaid rates for these essential services and ensure that individuals with brain injuries can continue to thrive and reach their optimal recoveries in community settings.