BILL ANALYSIS
AB 398
Page 1
Date of Hearing: March 31, 2009
ASSEMBLY COMMITTEE ON HEALTH
Dave Jones, Chair
AB 398 (Monning) - As Introduced: February 23, 2009
SUBJECT : Acquired brain trauma: administration.
SUMMARY : Transfers the administrative duties and oversight of
the California Traumatic Brain Injury (TBI) Program from the
Department of Mental Health (DMH) to the Department of
Rehabilitation (DOR).
EXISTING LAW :
1)Establishes the TBI Program within DMH and requires DMH to
designate project sites for a system of post-acute
continuum-of-care models for adults with TBIs. Sunsets the
TBI Program on July 1, 2012.
2)Requires DMH to ensure the TBI project sites coordinate
services to clients, including supported employment,
vocational services, day treatment, structured living
arrangements, and supported housing.
3)Establishes the State Penalty Fund (SPF) as a depository for
assessments on specified fines, penalties, and forfeitures
imposed and collected by the courts for specified offenses.
The money in the SPF is distributed monthly to other funds, as
specified.
4)Establishes funding for the TBI Program through the TBI Fund
which is funded by the monthly transfer of 0.66% of the SPF.
FISCAL EFFECT : This bill has not yet been analyzed by a fiscal
committee.
COMMENTS :
1)PURPOSE OF THIS BILL . According to the author, California is
home to the highest number of current TBI survivors in the
U.S., 350,000, and the ongoing wars in Afghanistan and Iraq
are adding to that number. The author points out that TBI is
primarily a traumatic physical injury rather than a mental
health condition, and, while DMH appropriately administers the
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state's mental health programs and services, it lacks the
personnel, issue area expertise, and the core mission to
address the myriad of physical injuries and symptoms that
constitute TBI. For these reasons, the author contends that
programs under the jurisdiction of DOR, which emphasize
rehabilitation and independent living, are better suited to
serve TBI survivors and their families.
2)BACKGROUND . TBI is caused by a blow or jolt to the head or a
penetrating head injury that disrupts the normal function of
the brain. According to the federal Centers for Disease
Control and Prevention, the leading causes of TBI are falls,
motor vehicle-traffic crashes, struck by or against events,
and assaults. Symptoms include post-traumatic stress
disorder, chronic fatigue, memory loss, poor attention and
concentration, sleep deprivation, loss of balance, confusion,
and sensitivity to light and sound.
According to the author, more than 100,000 Californians visit
emergency rooms each year due to head injuries and
approximately 25% of them never return to work. To address
the needs of this population, the TBI Program was created
within DMH in 1990 to coordinate services for adults with TBI
and enable them to lead productive and independent lives. DMH
administers the program through contracts with community
organizations that develop and operate seven hospital- and
community-based sites through California. The project sites
provide core services, including community reintegration,
family and community education, supported living, vocational
supports, and service coordination.
3)INTERAGENCY AGREEMENTS WITH DOR . In 1998, DMH and DOR teamed
up to develop vocational rehabilitation (VR) programs
specifically focused on the needs of adults with TBI.
Currently, three of the seven program sites participate in the
interagency agreement with DOR. These VR programs provide a
variety of services including vocational assessment, personal
vocational and social adjustment, work adjustment, employment
preparation, job development and placement, and job coaching.
The programs are designed to provide new, enhanced, or added
services that meet the local needs of DOR consumers and TBI
clients.
4)SUPPORT . The sponsors of this bill, the California Foundation
for Independent Living Centers and Traumatic Brain Injury
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Services of California, strongly believe that DOR has the
proven capacity and expertise to administer the existing
physical and vocational rehabilitation, peer counseling, job
referral, and other specialized programs and services that TBI
survivors need to achieve independent living. They note, for
example, that DOR already administers the state's Independent
Living Centers which are designed to maximize options for
independence for persons with disabilities. Several of the
TBI project sites, including the Central Coast Center for
Independent Living, the St. Jude Brain Injury Network, the
Mercy Healthcare Coordinated Care Project, and the Making
Headway Center for Brain Injury Recovery, state that TBI often
involves physical recovery from a traumatic incident and
transferring administrative oversight of the state's brain
injury services to DOR is most fitting for an agency whose
mission is focused on rehabilitation. The Disabled Veterans
Business Alliance writes that this bill is particularly
significant because the number of veterans suffering from TBI
will continue to grow with the overseas war on terrorism and
this bill will ensure that returning veterans have access to
programs and services directed at rehabilitation and recovery.
5)PRIOR LEGISLATION .
a) AB 1410 (Feuer), Chapter 676, Statutes of 2007, requires
the Department of Health Care Services to submit a home-
and community-based federal Medicaid waiver application or
state plan amendment by March 15, 2009, to serve at least
100 adults with acquired TBIs.
b) AB 1794 (Dutra), Chapter 414, Statutes of 2004, extends
the TBI Program until July 1, 2012.
c) AB 430 (Cardenas), Chapter 171, Statutes of 2001,
extends the TBI Program until July 1, 2007.
d) AB 1492 (Thomson), Chapter 1023, Statutes of 1999,
extends the TBI Program until January 1, 2005, and
authorizes expanding the program from four to seven sites
to the extent funds are available.
e) AB 3483 (Friedman), Chapter 197, Statutes of 1996,
extends the TBI Program sunset to January 1, 2000.
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f) SB 1457 (Mello), Chapter 508, Statutes of 1992, extends
the TBI Program to January 1, 1997.
g) SB 2232 (Seymour), Chapter 1292, Statutes of 1988,
establishes the three-year TBI Program within DMH and
directs DMH to fund project sites that provide the array of
services and assistance needed to meet the needs of
individuals with TBI and their families.
6)DOUBLE-REFERRAL . This bill is double-referred. Should this
bill pass this committee, it will be referred to the Assembly
Human Services Committee.
7)SUGGESTED AMENDMENT . Given that the TBI Program has been
renewed six times through legislation, the author may wish to
amend this bill to delete the sunset entirely and make the
program permanent.
REGISTERED SUPPORT / OPPOSITION :
Support
California Foundation for Independent Living Centers (sponsor)
Traumatic Brain Injury Services of California (sponsor)
American Federation of State, County and Municipal Employees,
AFL-CIO
California Ski and Snowboard Safety Organization
Central Coast Center for Independent Living
Disabled Veterans Business Alliance
Making Headway Center for Brain Injury Recovery
Mercy Healthcare Coordinated Care Project
San Francisco Traumatic Brain Injury Network
St. Jude Brain Injury Network
The Betty Clooney Foundation
Opposition
None on file.
Analysis Prepared by : Cassie Rafanan / HEALTH / (916)
319-2097