TBI Recognized as a Chronic Health Condition
In a victory for the brain injury community, the Centers for Medicare and Medicaid Services (CMS) have officially recognized traumatic brain injury (TBI) as a chronic health condition.
Starting in January 2025, TBI will be included in the list of chronic conditions covered by chronic special needs plans (C-SNPs) under the Medicare Advantage program. This landmark decision is a result of persistent advocacy by the Brain Injury Association of America (BIAA), which continues to fight for broader coverage of all types of brain injuries across public and private insurance plans.
“We are thrilled that CMS agrees with our stance that brain injury is a chronic health condition and has provided official recognition,” stated Rick Willis, President and CEO of BIAA. “This is an important first step in our fight to expand coverage for brain injury beyond acute care and helps us to make our case that brain injury should be treated by healthcare providers as a chronic condition like heart disease or diabetes.”
The inclusion of TBI as a chronic condition was included in a rule published in the Federal Register earlier this year. This official recognition marks a significant step forward in ensuring that brain injuries are more broadly acknowledged and treated as chronic conditions.
Earlier this year, BIAA released a position paper urging CMS and the Centers for Disease Control and Prevention (CDC) to designate brain injury as a chronic condition. According to the paper, formal recognition could lead to many benefits for individuals with brain injuries, including increased public health resources to address the lifelong impacts of brain injuries and enhanced benefits from health insurance plans like Medicare and Medicaid. The most important benefit, however, would be heightened public awareness of the long-term effects of brain injuries, which impact an estimated 5 million Americans.
“When we talk about recognizing, treating, and covering brain injury as a chronic condition, that last piece is making sure there are resources to continue providing support once a person with a brain injury leaves the acute care setting,” said Page Melton Ivie, Chair of the BIAA Board of Directors. “There is a lot of support in the hospital, but once you walk out the door, you’re on your own. We need to make sure we are continuing to support survivors and their families, because they are going to have a lot of needs that won’t be covered.”
BIAA is actively working to equip its affiliates like BIASC and individual advocates with the necessary tools to push for healthcare changes that reflect this new recognition, including ensuring that providers treat TBI as a chronic condition.
In the coming weeks, BIAA will provide more information on steps to increase access to care. A live Q&A session will be hosted to discuss these changes and share future tools and resources to help survivors and their loved ones advocate for expanded coverage.
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