Eliminates the 20 visits per year limit on medical assistance coverage for speech, physical and occupational therapies to persons with traumatic brain injury

2 Co-sponsors

• Greg Ball
• Michael F. Nozzolio

BILL NUMBER:S5851

Title of bill

An act to amend the social services law, in relation to the provision of speech therapy, physical therapy and occupational therapy to recipients of medical assistance

Purpose

To ensure that person with traumatic brain injury are provided appropri- ate and necessary therapies under the medical assistance program.

Summary of provisions

Section one of the bill amends subdivision two of section three hundred sixty five a of the social services law as amended by section twenty seven of part H of chapter 59 of the laws of two thousand eleven.

Statement in support

Legislation passed as part of 2011-2012 State Budget would limit speech therapy, physical therapy and occupational therapy to recipients of medical assistance to twenty times or less per year. While the law provided for exceptions for persons with developmental disabilities it did not provide such exceptions to person with traumatic brain injuries. Traumatic brain injury, often referred to as TBI, is most often an acute event similar to other injuries. That is where the similarity between traumatic brain injury and other injuries ends. One moment the person is normal and the next moment life has abruptly changed. In most other aspects, a traumatic brain injury is very different. The consequences of a brain injury can affect all aspects of an individual life including their personality. A brain injury is different from a broken limb or punctured lung. Brain injuries do not heal like other injuries. Recov- ery is a functional recovery, based on mechanisms that remain uncertain. No two brain injuries are alike and the consequence of two similar inju- ries may be very different. In this regard, therapeutic interventions such as speech, physical and occupational therapy are critical to an individual's ability to recover and/or maintain as many life skills as possible. In addition, the provisions of these therapies can be critical to maintaining an individual at home versus a more costly and restrict- ing setting such as a nursing home or other institutional setting. Therefore similar to other community based therapies, the elimination of this Cap for TBI is critical to achieving savings in Medicaid.

Fiscal implications

None.

Legislative history

This is a new bill.

Effective date

Same date and same manner as section 27 of part H of chapter 59 of the laws of 2011.