Figure: 28 TAC §21.3107(a)

NOTICE OF COVERAGE FOR ACQUIRED BRAIN INJURY

Your health benefit plan coverage for an acquired brain injury includes the following services
when they are medically necessary:

            –  Cognitive rehabilitation therapy

            –  Cognitive communication therapy

            –  Neurocognitive therapy and rehabilitation

            –  Neurobehavioral, neurophysiological, neuropsychological, and psychophysiological
testing and treatment

            –  Neurofeedback therapy and remediation

            –  Postacute transition services and community reintegration services, including
outpatient day treatment services or other post-acute-care treatment services

            –  Reasonable expenses related to periodic reevaluation of the care of an individual
covered under the plan who has incurred an acquired brain injury, has been unresponsive to
treatment, and becomes responsive to treatment at a later date, at which time the cognitive
rehabilitation services would be a covered benefit.

The fact that an acquired brain injury does not result in hospitalization or acute-care treatment
does not affect the right of the insured or the enrollee to receive the preceding treatments or
services commensurate with their condition.  Post-acute-care treatment or services may be
obtained in any facility where those services may legally be provided, including acute or
postacute rehabilitation hospitals and assisted living facilities regulated under the Health and
Safety Code.