West Virginia Code of State Rules Agency 197 - Traumatic Brain And Spinal Cord Injury Rehabilitation Fund
Overview
The Traumatic Brain and Spinal Cord Injury Rehabilitation Fund (TBI/SCI Fund) is a state-administered fund established to provide financial assistance for the rehabilitation, care, and support of individuals who have sustained traumatic brain injuries (TBI) or spinal cord injuries (SCI).
The rules under Agency 197 define the purpose, eligibility, administration, and procedures for the Fund. It ensures that victims of TBI or SCI receive appropriate rehabilitation and supportive services, especially when other sources of funding (insurance, federal programs) are insufficient.
Key Provisions
1. Purpose and Scope
The Fund is designed to:
Support medical rehabilitation, therapy, and treatment for individuals with TBI or SCI.
Provide financial assistance for adaptive equipment, assistive technology, and home modifications.
Improve quality of life and help individuals regain as much independence as possible.
The rules apply to all eligible residents of West Virginia who have sustained TBI or SCI and meet Fund criteria.
2. Definitions
Key terms in the rules include:
Traumatic Brain Injury (TBI): An acquired injury to the brain caused by an external force that results in physical, cognitive, emotional, or behavioral impairments.
Spinal Cord Injury (SCI): Damage to the spinal cord resulting in temporary or permanent loss of function, mobility, or sensation.
Fund Administrator: The official responsible for managing the TBI/SCI Fund, including application review, disbursement, and record-keeping.
Applicant: A person with TBI or SCI, or their legal representative, seeking financial assistance from the Fund.
3. Eligibility
To qualify for the Fund, an applicant must:
Be a resident of West Virginia.
Have a documented diagnosis of traumatic brain injury or spinal cord injury from a licensed healthcare provider.
Demonstrate financial need or a gap in funding from other sources (e.g., insurance, Medicaid, or Medicare).
Be seeking rehabilitation, medical care, adaptive equipment, or home modifications directly related to the TBI or SCI.
4. Application Process
Applications are submitted to the Fund Administrator using official forms.
Required information typically includes:
Medical records verifying the injury.
Detailed cost estimates for treatment, equipment, or rehabilitation services.
Evidence of other available funding sources.
Personal information and proof of residency.
Applications are reviewed for completeness, eligibility, and priority based on severity of injury, urgency, and availability of funds.
5. Use of Funds
Funds may be used for:
Rehabilitation Services: Physical therapy, occupational therapy, speech therapy, and other clinical interventions.
Medical Equipment: Wheelchairs, braces, orthotics, adaptive devices, or other medically necessary equipment.
Home and Vehicle Modifications: Ramps, lifts, accessible bathrooms, and other modifications required for mobility and independence.
Supportive Services: Counseling, respite care, and training for caregivers if directly related to TBI/SCI recovery.
6. Limits and Priorities
The Fund is not intended to replace insurance or other available financial resources.
Financial assistance is awarded based on priority, typically considering:
Severity of injury and functional impairment.
Level of financial need.
Expected benefit of the rehabilitation or equipment to the individual’s independence.
7. Monitoring and Accountability
Fund recipients must submit reports or documentation of how funds are used.
The Fund Administrator ensures:
Proper use of funds.
Compliance with state rules and guidelines.
Record-keeping for auditing and accountability.
Misuse of funds may result in repayment or denial of future assistance.
8. Appeals
Applicants may appeal decisions if funding is denied or reduced.
The appeals process includes:
Submission of a written request for review.
Opportunity to provide additional documentation or evidence.
A formal review and decision by the Fund Administrator or governing board.
9. Goals of the Fund
Ensure that individuals with TBI or SCI receive critical rehabilitation and support to maximize independence.
Reduce the financial burden of care for victims and their families.
Improve quality of life and community participation for residents affected by TBI or SCI.
Promote the effective and efficient use of state resources for rehabilitation purposes.
Summary
The Agency 197 – Traumatic Brain and Spinal Cord Injury Rehabilitation Fund provides targeted financial support for West Virginia residents who have suffered TBI or SCI. Through clear eligibility criteria, structured application procedures, and careful monitoring, the Fund helps ensure that individuals receive rehabilitation, adaptive equipment, and supportive services that improve their independence and quality of life.
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