BILL NUMBER: AB 398	CHAPTERED
	BILL TEXT

	CHAPTER  439
	FILED WITH SECRETARY OF STATE  OCTOBER 11, 2009
	APPROVED BY GOVERNOR  OCTOBER 11, 2009
	PASSED THE SENATE  AUGUST 31, 2009
	PASSED THE ASSEMBLY  SEPTEMBER 2, 2009
	AMENDED IN SENATE  JULY 23, 2009
	AMENDED IN SENATE  JUNE 30, 2009
	AMENDED IN SENATE  JUNE 25, 2009
	AMENDED IN SENATE  JUNE 16, 2009
	AMENDED IN ASSEMBLY  APRIL 14, 2009

INTRODUCED BY   Assembly Members Monning and Chesbro

                        FEBRUARY 23, 2009

   An act to amend Sections 4354, 4354.5, 4357, 4357.1, 4358.5, 4359,
and 14132.992 of, to repeal Section 4357.2 of, and to repeal and add
Sections 4355 and 4356 of, the Welfare and Institutions Code,
relating to acquired brain trauma.



	LEGISLATIVE COUNSEL'S DIGEST


   AB 398, Monning. Acquired brain trauma: administration.
   (1) Existing law establishes the State Department of Mental Health
and sets forth its powers and duties relating to the administration
of programs for the delivery of mental health services, including,
but not limited to, establishing the department as the agency
responsible for administering a program of services for persons with
acquired traumatic brain injury, as defined. This program provides
for a demonstration project for postacute care for adults 18 years of
age and older with an acquired traumatic brain injury, including the
funding of demonstration project sites, as specified.
   Existing law establishes the Department of Rehabilitation and sets
forth its powers and duties relating to rehabilitation services,
including, but not limited to, duties related to the delivery of
services for persons with acquired traumatic brain injury.
   This bill would remove the State Department of Mental Health as
the agency responsible for administering the program of services for
persons with acquired traumatic brain injury and would, instead,
establish the Department of Rehabilitation as the responsible agency
and would extend the existing July 1, 2012, repeal date for these
provisions until July 1, 2019.
   This bill would delete references to the program as a
demonstration project. It would, instead, dependent upon securing
sources of funding for the provision of services, require the
Department of Rehabilitation to fund an array of services for adults
18 years of age and older with acquired traumatic brain injury and
would require the department to determine the requirements for
service delivery, uniform data collection, and other aspects of
program administration that service providers participating in the
program must meet and to monitor and evaluate the performance of
those service providers, as specified.
   The bill would require service providers to furnish data to the
department and would require service providers wishing to continue to
participate in the program after July 1, 2013, to comply with
additional eligibility requirements specified by the department.
   Existing law establishes the Traumatic Brain Injury Fund in the
State Treasury, with this fund being available for purposes of the
program, upon appropriation by the Legislature. The fund receives
moneys from specified fines and penalties.
   This bill would allow the department to use the funds in the
Traumatic Brain Injury Fund to make grants to service providers for
the provision of services, as specified. It would also modify
requirements relating to the securing of matching funds.
   (2) Existing law provides for the Medi-Cal program, which is
administered by the State Department of Health Care Services,
pursuant to which medical benefits are provided to public assistance
recipients and certain other low-income persons. The Medi-Cal program
is partially governed and funded by federal Medicaid provisions.
   Existing law requires the department, by March 15, 2009, to submit
to the federal Centers for Medicare and Medicaid Services a home-
and community-based services waiver application or an amendment of
the state plan for home- and community-based services, to serve at
least 100 adults with acquired traumatic brain injuries who otherwise
would require care in a Medi-Cal funded nursing facility or an
intermediate care facility for persons with developmental
disabilities.
   This bill would, instead, require this waiver to be submitted by
March, 1, 2011.


THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:

  SECTION 1.  Section 4354 of the Welfare and Institutions Code is
amended to read:
   4354.  For purposes of this chapter, the following definitions
shall apply:
   (a) "Acquired traumatic brain injury" is an injury that is
sustained after birth from an external force to the brain or any of
its parts, resulting in cognitive, psychological, neurological, or
anatomical changes in brain functions.
   (b) "Department" means the State Department of Rehabilitation.
   (c) "Director" means the Director of Rehabilitation.
   (d) (1) "Vocational supportive services" means a method of
providing vocational rehabilitation and related services that may
include prevocational and educational services to individuals who are
unserved or underserved by existing vocational rehabilitation
services.
   (2) "Extended supported employment services" means ongoing support
services and other appropriate services that are needed to support
and maintain an individual with an acquired traumatic brain injury in
supported employment following that individual's transition from
support provided as a vocational rehabilitation service, including
job coaching, by the department, as defined in paragraphs (1) and (5)
of subdivision (a) of Section 19150.
   (e) The following four characteristics distinguish "vocational
supportive services" from traditional methods of providing vocational
rehabilitation and day activity services:
   (1) Service recipients appear to lack the potential for unassisted
competitive employment.
   (2) Ongoing training, supervision, and support services must be
provided.
   (3) The opportunity is designed to provide the same benefits that
other persons receive from work, including an adequate income level,
quality of working life, security, and mobility.
   (4) There is flexibility in the provision of support which is
necessary to enable the person to function effectively at the
worksite.
   (f) "Community reintegration services" means services as needed by
consumers, designed to develop, maintain, increase, or maximize
independent functioning, with the goal of living in the community and
participating in community life. These services may include, but are
not limited to, providing, or arranging for access to, housing,
transportation, medical care, rehabilitative therapies, day programs,
chemical dependency recovery programs, personal assistance, and
education.
   (g) "Fund" means the Traumatic Brain Injury Fund.
   (h) "Supported living services" means a range of appropriate
supervision, support, and training in the consumer's place of
residence, designed to maximize independence.
   (i) "Functional assessment" means measuring the level or degree of
independence, amount of assistance required, and speed and safety
considerations for a variety of categories, including activities of
daily living, mobility, communication skills, psychosocial
adjustment, and cognitive function.
   (j) "Residence" means the place where a consumer makes his or her
home, that may include, but is not limited to, a house or apartment
where the consumer lives independently, assistive living
arrangements, congregate housing, group homes, residential care
facilities, transitional living programs, and nursing facilities.
   (k) "Community rehabilitation program" shall have the same meaning
as contained in subdivision (5) of Section 705 of Title 29 of the
United States Code.
  SEC. 2.  Section 4354.5 of the Welfare and Institutions Code is
amended to read:
   4354.5.  The Legislature finds and declares all of the following:
   (a) Traumatic brain injuries have a long-term impact on the
survivors, their families, caregivers, and support systems.
   (b) Long-term care consumers experience great differences in
service levels, eligibility criteria, and service availability,
resulting in inappropriate and expensive care that fails to be
responsive to their needs.
   (c) To the maximum extent feasible, the department shall pursue
all available sources of federal financial participation, including,
but not limited to, the Medicaid home and community-based services
waiver program (42 U.S.C. Sec. 1396n(c)) and Part J of Subchapter II
of the Public Health Service Act (42 U.S.C. Sec. 280b et seq.).
   (d) If new sources of funding are secured which will permit
expanding the existing Traumatic Brain Injury Program, the department
shall fund an array of appropriate services and assistance to adults
18 years of age and older with traumatic brain injuries in those
areas of the state with the greatest need.
   (e) Implementation of this chapter shall be consistent with the
state's public policy strategy to design a coordinated services
delivery system pursuant to Article 4.05 (commencing with Section
14139.05) of Chapter 7 of Part 3 of Division 9.
  SEC. 3.  Section 4355 of the Welfare and Institutions Code is
repealed.
  SEC. 4.  Section 4355 is added to the Welfare and Institutions
Code, to read:
   4355.  (a) On or before January 1, 2012, the department shall
determine requirements related to service delivery, uniform data
collection, and other aspects of program administration, in addition
to those specified in Section 4357, that service providers
participating in the traumatic brain injury program must meet. This
may include, but is not limited to, the following:
   (1) The department may require that service providers be approved
as community rehabilitation programs eligible to serve consumers.
   (2) Upon approval of the Medicaid waiver sought pursuant to
Section 14132.992, the department may require that all service
providers do both of the following:
   (A) Satisfy all applicable eligibility requirements for provision
of services under the waiver.
   (B) Participate in the waiver and provide extended supported
employment services, as defined in paragraph (2) of subdivision (d)
of Section 4354.
   (b) On or before January 1, 2013, the department shall do all of
the following:
   (1) Determine the level of funding necessary to permit a service
provider to meet all applicable requirements and adequately serve its
designated service area.
   (2) Determine the number of sites that can be supported with
available funding.
   (3) Solicit applications from organizations interested in and
qualified to provide services pursuant to this chapter, and select
those best qualified to do so, with priority given to applicants that
have proven experience in providing effective services to persons
with acquired traumatic brain injuries, including, but not limited
to, supported living services, caregiver support, and family and
community education.
   (c) The department shall meet periodically with traumatic brain
injury service providers for discussion of topics, including, but not
limited to, the development and implementation of performance
standards and data collection processes, eligibility requirements,
program administration, pursuit of funding, implementation of the
Medicaid waiver, if approved by the federal government, and
refinement of the traumatic brain injury continuum of care.
  SEC. 5.  Section 4356 of the Welfare and Institutions Code is
repealed.
  SEC. 6.  Section 4356 is added to the Welfare and Institutions
Code, to read:
   4356.  Using data collected consistent with requirements
established pursuant to subdivision (a) of Section 4355, the
department shall monitor and evaluate the performance of service
providers.
  SEC. 7.  Section 4357 of the Welfare and Institutions Code is
amended to read:
   4357.  (a) Service providers shall identify the needs of consumers
and deliver services designed to meet those needs.
   (b) Service providers shall match not less than 20 percent of the
amount granted, with the exception of funds used for mentoring. The
required match may be cash or in-kind contributions, or a combination
of both, from the sites or any cooperating agency. In-kind
contributions may include, but shall not be limited to, staff and
volunteer services.
   (c) Service providers shall provide at least 51 percent of their
services under the grant to individuals who are Medi-Cal eligible or
who have no other identified third-party funding source.
   (d) (1) Service providers shall provide, directly or by
arrangement, a coordinated service model to include all of the
following:
   (A) Supported living services.
   (B) Community reintegration services.
   (C) Vocational supportive services.
   (D) Information, referral, and, as needed, assistance in
identifying, accessing, utilizing, and coordinating all services
needed by individuals with traumatic brain injury and their families.

   (E) Public and professional education designed to facilitate early
identification of persons with brain injury, prompt referral of
these persons to appropriate services, and improvement of the system
of services available to them.
   (2) The model shall be designed and modified with advice from
consumers and their families, and shall be accessible to the
population in need, taking into account transportation, linguistic,
and cultural factors.
   (e) Service providers shall develop and utilize an individual
service plan which will allow consumers to move from intensive
medical rehabilitation or highly structured living arrangements to
increased levels of independence and employment. The goals and
priorities of each consumer shall be an integral part of his or her
service plan.
   (f) Service providers shall seek all third-party reimbursements
for which consumers are eligible and shall utilize all services
otherwise available to consumers at no cost, including vocational
rehabilitation services provided by the department. However, grantees
may utilize grant dollars for the purchase of nonreimbursed services
or services otherwise unavailable to consumers.
   (g) Service providers shall endeavor to serve a population that is
broadly representative with regard to race and ethnicity of the
population with traumatic brain injury in their geographical service
area, undertaking outreach activities as needed to achieve this goal.

   (h) Service providers shall maintain a broad network of
relationships with local groups of brain injury survivors and
families of survivors, as well as local providers of health, social,
and vocational services to individuals with traumatic brain injury
and their families. The sites shall work cooperatively with these
groups and providers to improve and develop needed services and to
promote a well-coordinated service system, taking a leadership role
as necessary.
   (i) Service providers shall furnish uniform data to the department
pursuant to subdivision (a) of Section 4355 as necessary to monitor
and evaluate the program.
   (j) Service providers wishing to continue to participate in the
program after July 1, 2013, shall, by that date, be in compliance
with additional eligibility requirements established by the
department pursuant to Section 4355.
  SEC. 8.  Section 4357.1 of the Welfare and Institutions Code is
amended to read:
   4357.1.  (a) The department may make grants from the funds in the
Traumatic Brain Injury Fund, established in Section 4358, to service
providers for the purpose of carrying out the programs detailed in
this chapter.
   (b) Contracts or grants awarded pursuant to this chapter,
including contracts required for administration or ancillary services
in support of programs, shall be exempt from the requirements of the
Public Contract Code and the State Administrative Manual, and from
approval by the Department of General Services.
   (c) Grants awarded to service providers pursuant to this chapter
shall be subject to open competition every three years, unless the
department elects to extend one or more grants and delay competition
for those grants by a maximum of two additional years.
  SEC. 9.  Section 4357.2 of the Welfare and Institutions Code is
repealed.
  SEC. 10.  Section 4358.5 of the Welfare and Institutions Code is
amended to read:
   4358.5.  Funds deposited into the Traumatic Brain Injury Fund
pursuant to paragraph (8) of subdivision (f) of Section 1464 of the
Penal Code may be matched by federal vocational rehabilitation
services funds for implementation of the Traumatic Brain Injury
program pursuant to this chapter. However, this matching of funds
shall occur only to the extent it is permitted by other state and
federal law, and to the extent the matching of funds would be
consistent with the policies and priorities of the department.
  SEC. 11.  Section 4359 of the Welfare and Institutions Code is
amended to read:
   4359.  This chapter shall remain in effect until July 1, 2019, and
as of that date is repealed, unless a later enacted statute enacted
prior to July 1, 2019, extends or deletes that date.
  SEC. 12.  Section 14132.992 of the Welfare and Institutions Code is
amended to read:
   14132.992.  (a) (1) By March 15, 2011, the department shall submit
to the federal Centers for Medicare and Medicaid Services a home-
and community-based services waiver application pursuant to Section
1396n(c) of Title 42 of the United States Code, or an amendment of
the state plan for home- and community-based services pursuant to
Section 1396n(i) of Title 42 of the United States Code, to serve at
least 100 adults with acquired traumatic brain injuries who otherwise
would require care in a Medi-Cal funded nursing facility or an
intermediate care facility for persons with developmental
disabilities or, for the amendment of the state plan, who would meet
the eligibility criteria in Section 1396n(i).
   (2) As authorized by Section 1396n(c)(3) and 1396n(i)(3) of Title
42 of the United States Code, the waiver or amendment of the state
plan shall waive the statewide application of this section as well as
comparability of services so that waiver services may be provided by
one or more service providers designated to provide services to
persons with acquired traumatic brain injury pursuant to Chapter 5
(commencing with Section 4353) of Part 3 of Division 4.
   (3) The waiver services to be provided to eligible Medi-Cal
recipients shall include case management services, community
reintegration and supported living services, vocational supportive
services including prevocational services, neuropsychological
assessments, and rehabilitative services provided by service
providers currently serving persons with acquired traumatic brain
injuries pursuant to Chapter 5 (commencing with Section 4353).
   (4) The waiver services to be provided shall include as a
habilitation service pursuant to Section 1396n(c)(5) of Title 42 of
the United States Code "extended supported employment services" to
support and maintain an individual with an acquired traumatic brain
injury in supported employment following that individual's transition
from support provided as a vocational rehabilitation service,
including job coaching, by the State Department of Rehabilitation
pursuant to paragraphs (1) and (5) of subdivision (a) of Section
19150.
   (5) The waiver services to be provided shall include
rehabilitative therapies, including, but not limited to, occupational
therapy, physical therapy, speech therapy, and cognitive therapy,
that are different in kind and scope from state plan services.
   (6) The waiver shall require an aggregate cost-effectiveness
formula be used.
   (b) The development process of the home- and community-based
services waiver application or state plan amendment shall include the
solicitation of the opinions and help of the affected communities,
including representatives of service providers currently serving
persons with acquired traumatic brain injuries pursuant to Chapter 5
(commencing with Section 4353) of Part 3 of Division 4.
   (c) The waiver or state plan amendment shall be implemented only
if the following conditions are met:
   (1) Federal financial participation is available for the services
under the waiver or state plan amendment.
   (2) Cost neutrality is achieved in accordance with the terms and
conditions of the waiver or state plan amendment and the requirements
of the federal Centers for Medicare and Medicaid Services.
   (3) State funds are appropriated, otherwise made available, or
both, for this waiver or state plan amendment, including funds for
staff to develop, implement, administer, monitor, and oversee the
waiver or state plan amendment.
   (d) It is the intent of the Legislature that the home- and
community-based services waiver or state plan amendment augment funds
available to meet the needs of persons with acquired traumatic brain
injuries served by the participating service providers in accordance
with Chapter 5 (commencing with Section 4353) of Part 3 of Division
4.