The Traumatic Brain Injury (TBI) Act,  H.R. 4238 was introduced by Representative Bill Pascrell, Jr. (D-NJ) and Representative Todd Russell Platts (R-PA) on Wednesday, March 21, 2012 in the House of Representatives. Please call your Representative today to ask him or her to co-sponsor H.R. 4238. Specifically, BIAA would like constituents of the following members to call or email their Representative to ask them to cosponsor the bill. The Representatives listed below are members of the House Committee on Energy and Commerce, Subcommittee on Health.

Rep. Shimkus (IL-19-R)
Rep. Myrick (NC-9-R)
Rep. Murphy (PA-18-R)
Rep. McMorris Rogers (WA-5-R)
Rep. Capps (CA-23-D)
Rep. Ross (AR-4-D)
Rep. Bono Mack (CA-45-R)
Rep. DeGette (CO-1-D)
Rep. Doyle (PA-14-D)
Rep. Eshoo (CA-14-D)

The House Appropriations Committee approved spending allocations this week for its 12 appropriation bills which are aligned with a $1.028 trillion target for total discretionary spending set by the House’s fiscal 2013 budget resolution H Con Res 112. The figure is $19 billion less than what the Senate set for its discretionary spending limits. The House Appropriations Committee agreed to the following allocations for base discretionary budget authority for Labor-HHS-Education at $150 billion. This is $7.7 billion dollars less than the Senate budget for Labor-HHS-Education.

Last week the discretionary spending limits were set for the Senate’s FY 2013 Appropriations bills at $1.047 trillion, the limit established under the law PL 112-25, the Budget Control Act. The appropriators agreed to the following discretionary allocations of $157.7 billion for Labor-HHS-Education.

BIAA and NASHIA worked with the Congressional Brain Injury Task Force to issue a letter of support to appropriators urging them to preserve funding for both programs authorized by the TBI Act and the TBI Model Systems of Care Program.

BIAA is monitoring the appropriations process closely and will alert grassroots advocates if action becomes necessary.

The Traumatic Brain Injury (TBI) Act, H.R. 4238 was introduced by Representative Bill Pascrell, Jr. (D-NJ) and Representative Todd Russell Platts (R-PA) on Wednesday, March 21, 2012 in the House of Representatives. Please call your Representative today to ask him or her to co-sponsor H.R. 4238. Specifically, BIAA would like constituents of the following members to call or email their Representative to ask them to cosponsor the bill. The Representatives listed below are members of the House Committee on Energy and Commerce, Subcommittee on Health.

• Rep. Shimkus (IL-19-R)
• Rep. Myrick (NC-9-R)
• Rep. Murphy (PA-18-R)
• Rep. McMorris Rogers (WA-5-R)
• Rep. Capps (CA-23-D)
• Rep. Ross (AR-4-D)
• Rep. Bono Mack (CA-45-R)
• Rep. DeGette (CO-1-D)
• Rep. Doyle (PA-14-D)
• Rep. Eshoo (CA-14-D)

The Traumatic Brain Injury (TBI) Act, H.R. 4238 was introduced by Representative Bill Pascrell, Jr. (D-NJ) and Representative Todd Russell Platts (R-PA) on Wednesday, March 21, 2012 in the House of Representatives. Please call your Representative today to ask him or her to co-sponsor H.R. 4238. Specifically, BIAA would like constituents of the following members to call or email their Representative to ask them to cosponsor the bill. The Representatives listed below are members of the House Committee on Energy and Commerce, Subcommittee on Health.

Rep. Shimkus (IL-19-R)
Rep. Myrick (NC-9-R)
Rep. Murphy (PA-18-R)
Rep. McMorris Rogers (WA-5-R)
Rep. Capps (CA-23-D)
Rep. Ross (AR-4-D)
Rep. Bono Mack (CA-45-R)
Rep. DeGette (CO-1-D)
Rep. Doyle (PA-14-D)
Rep. Eshoo (CA-14-D)

Appropriations Update

The discretionary spending limits have been set for Senate’s FY 2013 Appropriations bills at $1.047 trillion, the limit established under the law PL 112-25, the Budget Control Act. The appropriators agreed to the following discretionary allocations of $157.7 billion for Labor-HHS-Education.

On March 29, the House adopted the budget resolution, H Con Res 112 by Budget Chairman Paul Ryan, R-Wis., that is $19 billion below the spending cap set in the August debt limit deal. The House is expected to vote on the caps next week.

BIAA and NASHIA worked with the Congressional Brain Injury Task Force to issue a letter of support to appropriators urging them to preserve funding for both programs authorized by the TBI Act and the TBI Model Systems of Care Program.

BIAA is monitoring the appropriations process closely and will alert grassroots advocates if action becomes necessary.

On April 12, 2012, BIAA submitted FY13 written testimony to both the Senate and House Appropriations Subcommittees on Labor Health and Human Services and Related Agencies. Both letters proposed the following funding increases for TBI Act programs and the TBI Model Systems of Care Program.

• $10 million (+ $4 million) for the Centers for Disease Control and Prevention TBI Registries and Surveillance, Brain Injury Acute Care Guidelines, Prevention and National Public Education/Awareness
• $8 million (+ $1 million) for the Health Resources and Services Administration (HRSA) Federal TBI State Grant Program
• $4 million (+ $1 million) for the HRSA Federal TBI Protection & Advocacy (P&A) Systems Grant Program
• $11 million (+ $1.5 million) for the TBI Model Systems of Care Program, and line item status within the broader NIDRR budget

Grassroots advocates should look for FY13 appropriations alerts in the coming months.

The Traumatic Brain Injury (TBI) Act, H.R. 4238 was introduced by Representative Bill Pascrell, Jr. (D-NJ) and Representative Todd Russell Platts (R-PA) on Wednesday, March 21, 2012 in the House of Representatives. Please call your Representative today to ask him or her to co-sponsor H.R. 4238. Specifically, BIAA would like constituents of the following members to call or email their Representative to ask them to cosponsor the bill. The Representatives listed below are members of the House Committee on Energy and Commerce, Subcommittee on Health.

Rep. Shimkus (IL-19-R)
Rep. Myrick (NC-9-R)
Rep. Murphy (PA-18-R)
Rep. McMorris Rogers (WA-5-R)
Rep. Capps (CA-23-D)
Rep. Ross (AR-4-D)
Rep. Bono Mack (CA-45-R)
Rep. DeGette (CO-1-D)
Rep. Doyle (PA-14-D)
Rep. Eshoo (CA-14-D)

This week, the U.S. Supreme Court heard oral debate with respect to the legal challenges of the Patient Protection and Affordable Care Act, otherwise known as the Affordable Care Act (ACA). The ACA was signed into law on March 23, 2010. The Supreme Court will now go behind closed doors to make decisions that could undo some or the entire health care reform bill championed by President Obama. A decision is expected on the issues in June.

The law establishes a minimum coverage requirement to ensure all Americans receive, at minimum, what is considered “essential” health care and also would require all individuals to purchase health insurance if they are not already covered. The ACA also expands Medicaid eligibility to individuals with income below the 133% of the poverty level.

This week, staff and members of BIAA’s Business and Professional Council met with several key agencies and organizations that will be involved in implementing aspects of the Patient Protection and Affordable Care Act, including:

• American Medical Rehabilitation Providers Association to exchange ideas on inpatient rehabilitation and the concept of Continuing Care Hospitals

• National Quality Forum to discuss measurers that pertain to brain injury treatment and care.

• Medicare Payment Advisory Commission to educate MedPAC statisticians and policy analysts about brain injury and discuss the impact of bundling of payments for post-acute care in brain injury.

• Center for Consumer Information and Insurance Oversight (CCIIO) to discuss the differences in neurological rehabilitation as compared to orthopedic rehabilitation.

• Patient-Centered Outcomes Research Institute (PCORI) to discuss the draft priorities for comparative effectiveness research required by the health reform law.

• CMS Center for Medicare and Medicaid Innovation (CMMI) to discuss innovations that could make brain injury rehabilitation and long-term care more available, acceptable and affordable for individuals who sustain injuries and public and private payers.

TBI Hearing – Subcommittee on Health

On March 19, 2012, the House Committee on Energy and Commerce’s Subcommittee on Health held a hearing entitled “A Review of Efforts to Prevent and Treat Traumatic Brain Injury.” Dr. Mark Ashley testified on behalf of the Brain Injury Association of America. You can read Dr. Ashley’s testimony and watch the hearing by going to BIAA’s website.

TBI Act Introduced in the House of Representatives

On Wednesday, March 21, 2012 Representative Bill Pascrell, Jr. (D-NJ) and Representative Todd Russell Platts (R-PA) introduced the Traumatic Brain Injury (TBI) Act, H.R. 4238. Please call your Representative today to ask him or her to co-sponsor H.R. 4238!

Problems with working memory, executive function, decision-making, inhibition, impulsivity, aggression, and social or emotional function are common after a traumatic brain injury. Although these skills and traits can vary considerably by the severity of injury, as well as variances in medical and social support, they are also influenced by genetics.

Scientists have isolated the specific genes that influence cognition and behaviors. These genes can act in unison to broadly affect a behavior, or they can target a single neurotransmitter or hormone that influences either the whole brain, or specific areas. Polymorphisms, which are variations of more than one associated gene, have the greatest influence on outcome after a brain injury.

A person’s genetic makeup is highly individual, and may only predispose a person to certain behaviors. The presence or absence of a specific gene may be devastating to outcome, or have no effect at all. However, when a potential outcome of a brain injury is uncertain, the identification of polymorphisms may be a helpful aid at both triage and in choosing interventions.

Weaver SM, Chau A, Portelli JN, & Grafman J. Genetic polymorphisms influence recovery from traumatic brain injury. The Neuroscientist. (March 2012).

The economic burden of a moderate to severe traumatic brain injury (TBI) is substantial. Aggressive medical procedures such as a decompressive craniectomy or invasive intracranial monitoring add further expense, and may not always contribute to a positive outcome. Past research about the cost-effectiveness of aggressive procedures after a TBI has been mixed.

However, a recent study found that, when compared to routine care of TBI, aggressive care is significantly cost-effective. Despite the higher initial cost of aggressive care, it results in a lower lifetime cost than routine care. Aggressive care was shown to be cost-effective across all age groups, including those over age 80. Routine care that primarily relies on providing comfort is associated with a poorer outcome and greater lifetime cost. Comfort care should be reserved for those who are clearly beyond the benefit of more aggressive treatment.

Whitmore RG, Thawani JP, Grady MS, et al. Is aggressive treatment of traumatic brain injury cost-effective? Journal of Neurosurgery. (March 2012).