The revised manual still does not include any significant requirements and/or procedures to address human and/or civil rights concerns of persons served. The only mention of rights I could find is on page 7, BIS Case Manager Staff Qualifications, where under 'BIS case managers must have knowledge of:' there is a bullet point for "Individuals' civil and human rights" (i.e., case managers must have knowledge of civil & human rights).

While important, it is insufficient for case managers to have knowledge of civil and human rights. The persons served, who as survivors of severe TBI meeting medical necessity criteria can be expected to have cognitive challenges, need to be aware of their rights in an accessible manner AND of the processes in place to protect them. This is not something to skip past or ignore.

Individuals with mental health, developmental disability, &/or substance abuse diagnoses have documented protections when their rights are alleged to have been violated. These are authorized for DBHDS support recipients under Title 37.2-400 of the Code of Virginia (1950), as amended, and can be found in the Support Coordination/Case Management Manual, DD Specific, from DBHDS. There is an Office of Human Rights with regional representatives, and there are local Human Rights Committees. Additionally, there is a DMAS Appeals portal.

Surely the brain injury population of Virginia also deserves some clear and specific process to allow for protection and advocacy for persons served from this vulnerable population. This is particularly true given that brain injury survivor supports are new to the DMAS system and there may be multiple foreseen and unforeseen "hiccups" along the way that could negatively impact individual human and civil rights.

We were told by a high ranking state employee that the requirement for CARF accreditation of STBI TCM providers is expected to cover any human rights concerns. While rights education and grievance processes are indeed part of CARF accreditation, these will be specific to the accredited agency and its policies and actions. CARF cannot and will not address a statewide absence of uniform rights protections and grievance procedures. It is a mistake to ignore this critical element of brain injury support provision in Virginia.