A North Carolina Public Health & Public Safety Initiative - Draft

A Policy + Legislative Hybrid Draft for the North Carolina General Assembly 

SECTION 1. TITLE

This act shall be known and may be cited as the “Brent Bill: Brain Health Screening and Safety Act.”

SECTION 2. PURPOSE

The purpose of this Act is to prevent tragedies like the documented case of Officer Brent Simpson, who experienced years of cognitive decline, personality changes, and neurological symptoms without receiving appropriate brain injury screening. Despite repeatedly stating that “something is wrong with my brain,” he was misdiagnosed, untreated for underlying neurological disease, and ultimately died by suicide. Postmortem analysis revealed early-stage chronic traumatic encephalopathy (CTE) and other neurological issues.

The purpose of this Act is to ensure that individuals who present with sudden behavioral, cognitive, or personality changes — and who have a history or reasonable likelihood of brain injury, concussion, head trauma, blast exposure, or other high‑risk activities — receive timely, evidence‑based screening for underlying brain injury, vascular conditions, infectious or inflammatory processes, and other medical causes of altered brain function.

The purpose of this Act is to ensure early identification of neurological conditions through validated screening tools and timely clinical evaluation. This Act integrates brain health into behavioral health, reduces misdiagnosis, improves treatment accuracy, and strengthens public safety and public health outcomes across North Carolina. 

SECTION 3. LEGISLATIVE FINDINGS

1. The General Assembly recognizes the documented case of Officer Brent Simpson of Charlotte, North Carolina, who repeatedly told his wife, “Something is wrong with my brain,” during the final years of his life, as reported by The New York Times. His sudden behavioral and cognitive decline reflects symptoms consistent with brain injury.

2. Officer Simpson experienced profound behavioral and personality changes. His wife described that “he became a different person,” reflecting symptoms consistent with a brain and neurological dysfunction. His injury was misdiagnosed by doctors in three (3) states.

3. Officer Simpson sustained repeated head impacts during his years as a defensive tactics instructor, including defensive tactics training, where he sparred with dozens of recruits multiple times per year, known as “ground & pound”.

4. Officer Simpson sought extensive medical care, undergoing multiple MRIs, EKG, 3D imaging, numerous blood tests, EMDR, EEG and months of inpatient treatment, as documented by his wife in her statement at his celebration of life.

5. He was evaluated by an Internist, Psychologist, Psychiatrist, Therapists, Dentist, Orthodontist, Ophthalmologist, ENT, and Neurologist, yet “there was no magic pill that could cure him or even alleviate his suffering.”

6. Despite this exhaustive medical workup, no provider screened him for brain injury. “An explanation for his cognitive decline remained elusive” until after his death, demonstrating a systemic failure to screen for underlying brain injury.

7. For almost two years, Officer Simpson experienced unbearable head pain, medication‑induced visual disturbances, and severe sleep disruption, consistent with organic neurological disease. Officer Simpson received psychiatric therapy and medications that may have worsened his condition.

8. Following his death, neuropathologist Dr. Ann McKee identified lesions in the frontal and temporal lobes of Officer Simpson’s brain, diagnosing him with early-stage CTE, making him the first publicly known law enforcement officer with the brain disease. These lesions, along with documented structural abnormalities, could explain his sudden behavioral and cognitive symptoms.

9. Many of the neuropathological findings present in Officer Simpson’s brain — including vascular injury, white‑matter degeneration, and regional atrophy — are detectable in living patients through appropriate clinical evaluation, neuroimaging, and vascular and inflammatory diagnostics. Individuals in high‑risk populations — including law enforcement, first responders, veterans, athletes, domestic violence survivors, and abused children — experience elevated exposure to head trauma, blast forces, and repeated sub concussive impacts.

10. Officer Simpson’s case demonstrates the urgent need for structured brain health screening when individuals present with sudden behavioral, cognitive, or personality changes, particularly in high-risk professions such as law enforcement. Officer Simpson’s case demonstrates that even individuals who seek help, undergo imaging, and follow medical advice may remain undiagnosed if providers are not required to screen for neurological causes of sudden behavioral change.

11. Brain injury (BI) is significantly underdiagnosed in North Carolina. Research shows that:

    • Up to 20% of high school athletes in contact sports sustain a concussion annually.

    • Up to 75% of domestic violence survivors have sustained at least one brain injury, often undiagnosed.

    • More than 450,000 U.S. service members have been diagnosed with BI since 2000, with many more undiagnosed.

    • Studies indicate that 40–60% of incarcerated individuals have a history of BI.

    • 2.1 million North Carolinians live with a disability — many related to neurological or cognitive conditions

12. The General Assembly finds that earlier identification of brain injury may prevent misdiagnosis, reduce suicide risk, mitigate drugs and alcohol use as self-medication, and improve treatment outcomes for individuals experiencing similar symptoms.

13. Screening and evaluation under this Act shall be conducted without bias, including occupational bias, and shall not assume behavioral or psychiatric causes without first ruling out neurological conditions.

14. This act utilizes the NC HealthConnex infrastructure to allow for consistent data exchange across medical disciplines, enabling mental health professionals to be a "part of the medical team" rather than isolated providers. It ends the "referral runaround" where patients are forced to tell their trauma story repeatedly. Identifying a brain injury early prevents years of "trial and error" with expensive psychiatric medications that do not work for organic brain disease.

15. The General Assembly finds that tactical, military, and law enforcement personnel are exposed to severe cumulative brain trauma not only in active field operations, but through continuous exposure in training environments where "train as you fight" realism creates repeated sub-concussive impacts and blast forces. Continuous occupational exposure without sufficient rest generates toxic neuroinflammation that alters signaling structures and slowly degrades brain tissue over time. Because behavioral dysregulation and psychiatric distress are often the very first outward indicators that physical brain damage has occurred, a mandatory diagnostic standard must be established to rule out structural damage before locking a patient into a psychiatric-only clinical track.

SECTION 4. DEFINITIONS

For purposes of this Act:

1. “Brain Injury (BI)” means an injury to the brain caused by external force, including concussion, blast exposure, repeated sub concussive impacts, or assault.

2. “High‑risk populations” include:

   • Athletes in collision or contact sports

   • Domestic violence survivors

   • Children with suspected abuse

   • Military personnel and veterans

   • First responders and law enforcement personnel

   • Individuals with repeated head trauma or blast exposure

3. “Sudden Personality or Behavioral Change” means a rapid or unexplained shift in temperament, impulse control, social functioning, or personality traits that deviates significantly from an individual's established baseline. For the purposes of this Act, such changes in high-risk populations shall be clinically presumed to have an Organic Etiology—meaning a cause rooted in physical brain injury, neuro-inflammation, or neurodegeneration—until a comprehensive neurological evaluation proves otherwise.

4. “Tiered diagnostic screening” means a structured, stepwise evaluation process beginning with low‑cost history and neurocognitive tools and escalating to advanced physiological diagnostics when clinically indicated.

5. “Clinically indicated” means justified by accepted medical standards and professional judgment.

6. “Traumatic Encephalopathy Syndrome (TES) Assessment” means the clinical diagnostic framework established by the National Institute of Neurological Disorders and Stroke (NINDS) to evaluate patients suffering from long-term, low-level, or repetitive non-concussive exposure.

SECTION 5. BRAIN HEALTH SCREENING REQUIREMENTS

(a) Tier 1: Mandatory Screening in High‑Risk Cases

Any inpatient/outpatient medical or psychiatric facility where cognitive, behavioral, drug and alcohol treatment and/or therapy is provided, any licensed mental health professional, primary care provider, emergency department clinician, or school‑based health provider conducting an evaluation for sudden behavioral or cognitive change shall administer:

1. The Ohio State University TBI Identification Method (OSU-TBI) or a functionally equivalent validated tool to capture a comprehensive, lifetime history of physical brain trauma, sub-concussive hits, or blast exposures. General intake questions shall not satisfy this requirement.

2. A structured evaluation utilizing the four core diagnostic inquiries of the NINDS Traumatic Encephalopathy Syndrome (TES) protocol: 

   •  First, is there a documented occupational, athletic, or situational history of single or cumulative head impacts or blast exposures?  

   • Second, is the patient experiencing a quantifiable behavioral, psychological, or cognitive disorder?  

   • Third, is the behavioral, psychological, or cognitive presentation progressively worsening?  

   • Fourth, are there co-occurring pre-dispositions (genetic, environmental, or chemical) that may interact with the presentation?  

3. A brief neurocognitive screening instrument

4. Clinical evaluation shall include review of collateral information, including input from family members or caregivers when available, and review of relevant medical history.

(b) Tier 2: Clinical Evaluation

If Tier 1 screening indicates a history of exposure and a positive risk indicator for brain injury, the provider shall escalate the case:

1. Refer the individual for a neurology, physiatry, or neuropsychology evaluation.

2. Mandatory Linkage: Referrals shall trigger immediate administrative alignment with the NASHIA Resource Facilitation (RF) model. The evaluating professional shall initiate a formal connection with the state-designated Brain Injury Resource Center (or the Brain Injury Association of North Carolina) to provide a dedicated navigator who will assist the patient with specialty scheduling and care continuity.

(c) Tier 3: Medical Diagnostics and Advance Neuroimaging

If Tier 2 evaluation indicates a physical or structural etiology, the evaluating clinician may order advanced medical diagnostics to substantiate the presence of organic brain degradation, axonal stretching, vascular injury, or neuroinflammation. Insurers shall cover, and providers may order, the following advanced modalities when clinically indicated:  

1. Magnetic Resonance Imaging (MRI), Computed Tomography (CT), or Positron Emission Tomography (PET) imaging.

2. Diffusion Tensor Imaging (DTI) to identify microstructural white-matter tract damage and axonal shearing caused by cumulative impact or cavitation.  

3. Quantitative EEG (QEEG) to map electrical brainwave abnormalities and localized cortical dysfunction.  

4. SPECT Scans to evaluate regional cerebral blood-flow deficits correlating to executive and behavioral changes.  

5. Functional MRI (fMRI) to assess real-time cognitive processing limitations.  

6. Vascular imaging, infectious/inflammatory laboratory testing, and blood-based biomarker measurements consistent with the CBI-M framework.

7. Infectious and Neuro-Inflammatory Panels: Including, but not limited to, specialized serology or cerebrospinal fluid analysis to rule out neuroborreliosis, post-infectious autoimmune encephalitis, or other pathogen-driven central nervous system inflammation. Insurers are prohibited from denying these panels under Section 8 if a neurological etiology is clinically suspect

(d) Clinical Judgment Preserved

Nothing in this Act shall be construed to require advanced imaging or diagnostics when they are not medically indicated by the preceding tiers.

(e) Decision Matrix Knowledge/Detection | Responsibility/Action - TBD

SECTION 6. TECHNICAL INTEROPERABILITY & CONTINUITY OF CARE

1. Mandatory Data Integration: Every licensed professional who documents a "Positive Risk Indicator" via a Tier 1 screening under this Act shall submit the screening data to the North Carolina Health Information Exchange (NC HealthConnex) within 72 hours of completion.

2. The Brain Health Flag: The NC HIE Authority shall establish a discrete, searchable, and standardized electronic data element known as the "Brent Bill Brain Health Risk Indicator." This diagnostic flag shall be immediately visible to any treating medical provider, emergency clinician, or specialist pulling up the patient's unified record across differing hospital networks or medical groups.

3. Privacy Protections: Submissions to NC HealthConnex shall be strictly limited to objective screening metrics (trauma history indexes and neurocognitive scores) and shall explicitly exclude protected psychotherapy notes, ensuring absolute HIPAA compliance while maintaining systemic diagnostic urgency.

SECTION 7. PROFESSIONAL RESPONSIBILITY AND THE DUTY TO ESCALATE

1. The Duty of Informed Response: Any licensed professional who identifies a "Positive Risk Indicator" during a Tier 1 screening has reached the threshold of possessing sufficient knowledge to act. The provider shall have an affirmative statutory duty to escalate the patient's care pathway from a standalone psychiatric track to a neurological track.

2. Mandatory Referral Requirement: Once this threshold is crossed, the professional must initiate the Tier 2 referral and the NASHIA-aligned resource linkage. Failure to execute this referral, or failure to explicitly document a sound, evidence-based clinical justification for non-referral in the patient's permanent record, shall be defined as a deviation from the established North Carolina Medical Standard of Care.

3. Accountability over Immunity: Compliance with the screening, data-sharing, and escalation protocols of this Act shall serve as the primary legal evidence of professional competence in brain-health-first diagnostics. This section does not grant immunity for diagnostic negligence; instead, it establishes an enforceable, objective benchmark for professional accountability.

SECTION 8. INSURANCE AND MEDICAID COVERAGE

1. Coverage & Billing Requirements: Insurers, Medicaid, and state-managed health entities shall recognize a positive Tier 1 screen as an absolute, primary Medical Necessity Trigger for Tier 2 consultations and Tier 3 diagnostics.

2. Utilization of Traumatic Brain Injury Billing Codes: To eliminate administrative blocks and code rejections within commercial medicine, insurers and state health plans shall expand the definitions and covered protocols under existing Traumatic Brain Injury (TBI) and mild Traumatic Brain Injury (mTBI) billing codes to encompass cumulative occupational hazards, repeated head impacts (RHI), and repetitive blast exposures (RBE). Licensed clinicians shall be authorized to utilize these established TBI billing codes to process and secure immediate coverage for all diagnostics mandated under this Act.  

3. Statutory Referral Authority: A documented positive Tier 1 screening signed by a licensed Mental Health Professional (MHP)—including licensed clinical social workers and licensed clinical mental health counselors—shall be recognized by insurers as a legally valid medical referral. Insurers are prohibited from requiring an intervening, duplicative evaluation by a Primary Care Physician (PCP) as a condition to authorize or pay for the Tier 2 neurological consultation.

4. Elimination of Pre-Authorization and "Fail-First" Blocks: Insurers shall not deny, delay, or require prior-authorization for Tier 2 or Tier 3 diagnostic testing for patients meeting the criteria of this Act. Insurers are strictly prohibited from requiring a patient to "fail" a course of psychotherapy, undergo psychiatric stabilization, or exhaust behavioral health pharmaceutical modalities as a prerequisite for approving advanced neuroimaging or specialty evaluation.

5. Parity and No Blanket Denials: Coverage shall be maintained in strict alignment with federal and state mental health parity laws. Insurers may not issue denials or refuse coverage for neurological evaluations solely because the patient's primary outward presentation or intake code is behavioral, psychological, or psychiatric.

6. Primacy of Organic Assessment: When a patient in a high-risk population presents with severe behavioral or cognitive dysfunction alongside a positive history of physical brain trauma, the medical evaluation of organic neurological etiologies shall take clinical and diagnostic precedence over purely functional psychiatric assumptions.

SECTION 9. PRIVACY AND CONSENT PROTECTIONS

1. All screenings, advanced imaging, and diagnostic testing under this Act shall require explicit informed consent, except where otherwise permitted by law for emergency, life-saving medical care.

2. Neurological diagnostic results, brain scans, or screening data generated solely as a result of this Act shall be treated as privileged medical data and shall not be used in criminal prosecutions without the individual’s express, written consent.

3. No individual shall be compelled to undergo advanced neuroimaging absent an objective medical necessity determined by a licensed physician or a direct order from a court of competent jurisdiction.

SECTION 10. IMPLEMENTATION, EXECUTION, AND AGENCY RULEMAKING

(a) Joint Agency Task Force for Brain Health Integration Within sixty (60) days of this Act becoming law, the Secretary of the North Carolina Department of Health and Human Services (DHHS) and the Commissioner of the North Carolina Department of Insurance (DOI) shall establish an internal, non-bureaucratic Joint Task Force. The purpose of this task force is to synchronize the medical standards mandated in Section 5 with the insurance enforcement mechanisms mandated in Section 8.

(b) Technical Execution Timeline for NC HealthConnex The North Carolina Health Information Exchange Authority shall be given a period of one hundred and eighty (180) days from the effective date of this Act to complete the technical architecture for the “Brent Bill Brain Health Risk Indicator" flag within the NC HealthConnex portal, as mandated in Section 6.

1. The Authority shall provide a standardized, secure API or data-entry template for electronic health record (EHR) vendors operating within the state to ensure plug-and-play deployment for practicing clinicians.

2. The submission of this diagnostic flag shall be automated upon a provider checking the "Positive History" box on the digitized OSU-TBI screening interface.

(c) Workforce Readiness via Existing Licensing Boards To execute the workforce training mandates in Section 7 without drawing from the state's general fund, DHHS shall not create independent training programs. Instead, the mandate shall be executed through existing professional licensing boards:

1. The NC Medical Board, NC Board of Nursing, and NC Social Work Certification and Licensure Board shall require all licensed professionals treating high-risk populations to complete a one-time, two-hour Continuing Medical Education (CME) or Continuing Education (CE) course on the intersection of repetitive brain trauma, neuroinflammation, and psychiatric symptomology.

2. These boards shall adopt pre-existing, open-source training curricula validated by NINDS and NASHIA to eliminate curriculum development costs.

(d) Enforcement and Regulatory Teeth via the Department of Insurance (DOI) The Commissioner of Insurance shall promulgate rules and market conduct actions to ensure immediate compliance by commercial insurers under Section 8.

1. Any commercial insurer operating within the state that issues an automated or manual denial for a Tier 2 or Tier 3 diagnostic consult where a "Brent Bill Brain Health Risk Indicator" has been logged in NC HealthConnex shall be subject to an automatic administrative review by the DOI.

2. Insurers found to be systematically violating the "Primacy of Organic Assessment" clause by requiring psychiatric stabilization prior to neurological rule-outs shall be subject to civil monetary penalties under Chapter 58 of the North Carolina General Statutes.

SECTION 11. REPORTING

1. Annual Reporting Standard: DHHS shall maintain the standard of care under this Act, updating the recognized tools every two years in accordance with emerging neuropathological data. DHHS shall submit an annual report to the General Assembly tracking:

   • The aggregate number of Tier 1 screenings completed across the state.

   • The percentage of screenings yielding positive risk indicators.

   • The conversion and re-diagnosis rate (the number of patients initially coded with a standalone psychiatric illness who were correctly identified as possessing an organic brain injury or neurological disease).

   • Cost-avoidance data mapping the reduction of prolonged, ineffective psychiatric institutionalizations against early neurological detection.

SECTION 1x. EFFECTIVE DATE

This Act becomes effective July 1, 202x.