QUEST Integration – Cognitive Rehabilitation Services

Original Effective Date:

10/01/2009

Current Effective Date:

01/01/2015

Services to cognitively impaired persons, commonly those with traumatic brain injury, that assess and treat communication skills, cognitive and behavioral ability, and cognitive skills related to performing activities of daily living are covered.Treatment may last up to one year if the member is making progress.

Reassessments should be completed at regular intervals, as determined by the provider and according to the assessed needs, treatment goals and objectives.

Cognitive Skills Areas

Five cognitive skills areas should be comprehensively assessed and, as appropriate, treated:

• Attention skills – sustained, selective, alternating, and divided
• Visual processing skills – acuity, oculomotor control, fields, visual attention, scanning, pattern recognition, visual memory, or perception
• Information processing skills – auditory or other sensory processing skills, organizational skills, speed, and capacity of processing
• Memory skills – orientation, episodic, prospective, encoding, storage, consolidation, and recall
• Executive function skills – self-awareness, goal setting, self-initiation, self-inhibition, planning and organization, self-monitoring, self-evaluation, flexible problem solving, and metacognition

Approaches and Techniques/Strategies

Approaches that can be used to provide cognitive rehabilitation include:

• Education
• Process training
• Strategy development and implementation
• Functional application

Approved cognitive rehabilitation techniques/strategies include:

• Speech/language/communication – addressing the member’s articulation, distortions, and phonological disorders, including: 1) inappropriate pitch, loudness, quality or total loss of speech, and fluency disorder or stuttering and 2) training on the tools needed to effectively communicate wants and needs.
• Neuropsychological assessment – providing an objective and quantitative assessment of a member’s functioning following a neurological illness or injury. The evaluation consists of the administration of a series of objective tests, designed to provide specific information about the member’s current cognitive and emotional functioning.
• Compensatory memory techniques – improving functions of attention and concentration that can impact on the member’s ability to regain independence in daily living activities as well as in auditory processing, planning, problem solving, decision making, and memory functions.
• Executive functions strategies – teaching the member to engage in self-appraisal of strengths and weakness, setting goals, self-monitoring, self-evaluating and problem solving.
• Reading/writing skills retraining – relearning levels of writing and reading structure and content to member’s maximum potential.

Revision History