BILL NUMBER: AB 398 AMENDED
BILL TEXT
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, 4357, and 4358.5
4354.5, 4357, 4357.1, 4358.5, and 14132.992 of,
and to add Section 4354.6 to, to repeal
Section 4359 of Sections 4357.2 and 4359 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, as amended, Monning. Acquired brain trauma:
administration.
Existing
(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 4
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 delete the existing July 1, 2012, repeal date for
these provisions , and would make conforming changes
.
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.
Vote: majority. Appropriation: no. Fiscal committee: yes.
State-mandated local program: no.
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
clients 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 client's
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 client
consumer makes his or her home, that may include, but is
not limited to, a house or apartment where the client
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 both of the
following:
(a) Ascertaining the number of Californians who survive traumatic
brain injuries is difficult, but the best estimates are that there
are approximately 225,000 survivors who have sustained "closed" or
"open" head injuries.
(b)
(a) Traumatic brain injuries have a long-term impact on
the survivors, their families, caregivers, and support systems.
(c)
(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.
(d) California must develop an action plan with a timetable for
implementation to ensure that there will be an array of appropriate
services and assistance funded and administered by a state structure
that has a focus and commitment to integration and coordination.
(e) The state must pursue, in a timely manner, 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.).
(f) The department, pursuant to this chapter, has funded and
demonstrated, successfully, through four projects for a postacute
continuum-of-care model for adults 18 years of age or older with
acquired traumatic brain injuries, the array of services and
assistance that meet the needs of these individuals and their
families.
(g) The state shall replicate these models toward developing a
statewide system that has as a goal the support of existing
community-based agencies and organizations with a proven record of
serving survivors of traumatic brain injuries.
(h) Implementation of the act that added this section 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 4354.6 is added to the
Welfare and Institutions Code , to read:
4354.6. (a) 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.).
(b) 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.
(c) Implementation of the act that added this section 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. 4. Section 4355 of the Welfare and
Institutions Code is repealed.
4355. (a) The department shall designate sites in order to
develop a system of postacute continuum-of-care models for adults 18
years of age or older with an acquired traumatic brain injury.
(b) The project sites shall coordinate vocational supportive
services, community reintegration services, and supported living
services. The purpose of the project is to demonstrate the
effectiveness of a coordinated service approach that furthers the
goal of assisting those persons to attain productive, independent
lives which may include paid employment.
(c) Project sites that are authorized to provide home- and
community-based waiver services pursuant to Section 14132.992 shall
also provide extended supported employment services, as defined in
paragraph (2) of subdivision (d) of Section 4354.
SEC. 5. 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. 6. Section 4356 of the Welfare and
Institutions Code is repealed.
4356. (a) The department shall provide support to the four
original pilot sites.
(b) (1) The department shall award and administer grants to four
additional sites, to be selected through a competitive bidding
process. One site shall be within each of the regions listed in
Section 4357.2. It is the intent of the Legislature that one site be
located in a rural area. Implementation of new project sites shall be
contingent upon the availability of funds, and new project sites
shall be selected on an incremental basis as funds become available.
(2) Priority shall be given to applicants that have proven
experience in providing services to persons with an acquired
traumatic brain injury including, but not limited to, supported
living services, community reintegration services, vocational support
services, caregiver support, and family and community education.
(3) The department shall convene a working group, established
pursuant to Section 4357.1, to assist them in developing requests for
proposals and evaluating bids. In addition, the department shall use
this working group as an advisory committee in accordance with
requirements of Part J of Subchapter II of the Public Health Service
Act (42 U.S.C. Sec. 280b et seq.) in order to pursue available
federal funds including, but not limited to, Section 300d-52 of Title
42 of the United States Code.
(4) Each new site shall be in operation within six months
following the grant award.
(5) The four additional sites prescribed by this subdivision shall
be established to the extent that the availability of federal funds
or other appropriate funds permit.
(c) (1) The department, with the advice and assistance of the
working group, shall develop an independent evaluation and assist
sites in collecting uniform data on all clients.
(2) The evaluation shall test the efficacy, individually and in
the aggregate, of the existing and new project sites in the following
areas:
(A) The degree of community reintegration achieved by clients,
including their increased ability to independently carry out
activities of daily living, increased participation in community
life, and improved living arrangements.
(B) The improvements in clients' prevocational and vocational
abilities, educational attainment, and paid and volunteer job
placements.
(C) Client and family satisfaction with services provided.
(D) Number of clients, family members, health and social service
professionals, law enforcement professionals, and other persons
receiving education and training designed to improve their
understanding of the nature and consequences of traumatic brain
injury, as well as any documented outcomes of that training and
education.
(E) The extent to which participating programs result in reduced
state costs for institutionalization or higher levels of care, if
such an estimate can be obtained within the 10 percent of funds
allowed for the evaluation.
(3) The department shall expend not more than 10 percent of the
annual program amount on the evaluation. The evaluator shall be
chosen by means of competitive bid and shall report to the
department.
(4) The evaluator shall make a final report to the Legislature by
January 1, 2005.
SEC. 7. 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. 2. SEC. 8. Section 4357 of the
Welfare and Institutions Code is amended to read:
4357. (a) The sites shall be able to identify the special needs
and problems of clients and the services shall be designed to meet
4357. (a) Service providers
shall identify the needs of consumers and deliver services designed
to meet those needs.
(b) The sites 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) The sites 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) The sites (1)
Service providers shall provide, directly or by arrangement, a
coordinated service model to include all of the following:
(1)
(A) Supported living services.
(2)
(B) Community reintegration services.
(3)
(C) Vocational supportive services.
(4)
(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.
(5) (A)
(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.
(B)
(2) The model shall be designed and modified with
advice from clients consumers and their
families, and shall be accessible to the population in need, taking
into account transportation, linguistic, and cultural factors.
(e) The sites Service providers shall
develop and utilize an individual service plan which will allow
clients 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 client consumer
shall be an integral part of his or her service plan.
(f) The sites Service providers
shall seek all third-party reimbursements for which clients
consumers are eligible and shall utilize all
services otherwise available to clients
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 clients consumers
.
(g) The sites 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) The sites 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. 9. Section 4357.1 of the Welfare
and Institutions Code is amended to read:
4357.1. (a) The department shall convene a working group
including the following persons as selected by the director:
(1) A survivor currently using services in the program.
(2) Two family members of persons surviving traumatic brain
injuries, one of whom shall be a family member of a person with
significant disabilities resulting from injuries.
(3) A representative of the Brain Injury Association of
California.
(4) A representative of each of the existing sites.
(5) A representative of the Caregiver Resource Centers.
(6) A representative of the California Foundation for Independent
Living Centers.
(7) A representative of the Public Interest Center for Long-term
Care.
(8) A representative of the California Rehabilitation Association.
(9) A member from a survivor's organization.
(10) Representatives of the Department of Rehabilitation and the
State Department of Health Services and others as determined by the
director.
(b) Members of the working group shall participate without
compensation. The working group may be reimbursed by the department
for expenses related to the meetings, as determined by the director.
(c) The department shall consult with the working group on the
following, as determined by the director:
(1) Development of the evaluation instrument and plan.
(2) Selection and development of the four new sites.
(3) Progress reports and input from participating state or local
agencies and the public.
(4) Project implementation, achievements, and recommendations
regarding project improvement.
(5) Development of recommended strategies and guidelines for
accident prevention and training of peace officers in awareness of
brain injury issues. These recommendations shall be made available
for use by the department, project sites, other state agencies, and
other appropriate entities.
(6) A recommended plan including financial requirements for
expansion of the project to all regions of the state to be completed
and issued by January 1, 2003.
(d)
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 part and Part 4 (commencing with Section 4370)
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. 10. Section 4357.2 of the Welfare
and Institutions Code is repealed.
4357.2. (a) New sites shall be chosen from areas of the state
that are not currently served by a site. Two new sites shall be
located in the southern portion of the state and two new sites shall
be located in the northern portion of the state. Of these, at least
one site shall be located in a rural area. Nothing in this chapter
shall prohibit a site from serving multiple counties. Implementation
of the new sites shall be contingent upon funds appropriated by the
Legislature and funds becoming available for this purpose.
(b) The department, in conjunction with the existing sites, shall
develop guidelines and procedures for the coordinated
continuum-of-care model and its component services. The existing
sites shall assist the department in providing orientation, training,
and technical assistance to the new sites.
(c) Up to 10 percent of funds allocated to new sites during their
first year of operation may be expended for training, technical
assistance, and mentoring by existing sites and any other source of
assistance appropriate to the needs of the new sites. A plan and
budget for technical assistance and mentoring shall be included in
the proposals submitted by potential sites.
(d) Mentoring activities shall include, but not be limited to,
assisting new sites in refining their continuum-of-care model and its
component services, developing guidelines and procedures, and
providing advice in meeting the needs of traumatic brain injury
survivors and their caregivers, as well as carrying out community
outreach and networking with community groups and service providers.
Mentoring shall be carried out with the goal of responding to the
needs identified by the new sites, transferring the knowledge and
expertise of the existing sites, and helping each new site to be
successful in developing an effective program that takes into account
the needs, resources, and priorities of their local community.
Mentoring shall be coordinated with and overseen by the department.
(e) Department staff and site directors shall meet quarterly as a
group for ongoing technical assistance, transfer of knowledge, and
refinement of the models of continuum of care.
(f) Existing and new sites may allocate up to 15 percent of annual
program funds to any appropriate caregiver resource center to assist
in caregiver services.
SEC. 3. SEC. 11. Section 4358.5 of
the Welfare and Institutions Code is amended to read:
4358.5. (a) Funds deposited
into the Traumatic Brain Injury Fund pursuant to paragraph (8) of
subdivision (f) of Section 1464 of the Penal Code shall
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 be required occur only
to the extent it is required 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 regarding funding
.
(b) The department shall seek and secure funding from available
federal resources, including, but not limited to, Medicaid and drug
and alcohol funds, utilizing the Traumatic Brain Injury Fund as the
state's share for obtaining federal financial participation, and
shall seek any necessary waiver of federal program requirements to
maximize available federal dollars.
SEC. 4. SEC. 12. Section 4359 of the
Welfare and Institutions Code is repealed.
SEC. 13. Section 14132.992 of the
Welfare and Institutions Code is amended to read:
14132.992. (a) (1) By March 15, 2009 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 of the sites service providers
designated to provide services to persons with acquired
traumatic brain injury pursuant to Section 4356
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 project
sites 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 the working group members pursuant to Section
4357.1 and representatives of project sites
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 project sites
service providers in accordance with
subdivision (b) of Section 4358.5 Chapter 5
(commencing with Section 4353) of Part 3 of Division 4
.