BILL ANALYSIS
AB 398
Page 1
Date of Hearing: April 28, 2009
ASSEMBLY COMMITTEE ON HUMAN SERVICES
Jim Beall, Jr., Chair
AB 398 (Monning) - As Amended: April 14, 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), and deletes the program's sunset date.
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 : Unknown
COMMENTS :
PURPOSE OF THIS BILL . According to the author, California is
home to the highest number of current TBI survivors in the
nation (350,000), and the ongoing wars in Afghanistan and Iraq
are adding to that number. The author says that TBI is
primarily a traumatic physical injury rather than a mental
health condition and, while DMH appropriately administers the
state's mental health programs and services, it lacks the
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personnel, issue area expertise, and the core mission to address
the myriad 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.
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 DMH's web site, it has oversight of a public mental
health budget of more than $4 billion and employs more than
10,000 employees throughout its six locations. Its
responsibilities include:
a) Providing leadership for local county mental health
departments;
b) Evaluation and monitoring of public mental health
programs;
c) Administration of federal funds for mental health
programs and services;
d) The care and treatment of people with mental illness at
the five state mental hospitals (Atascadero, Metropolitan,
Napa, Coalinga and Patton State Hospitals) and at the Acute
Psychiatric Programs located at the California Medical
Facilities in Vacaville and Salinas Valley; and
e) Implementation of the Mental Health Services Act
(Proposition 63), which provides state tax dollars for
specific county mental health programs and services.
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The California Department of Rehabilitation (DOR) administers
the largest vocational rehabilitation program in the country.
It has a three-pronged mission to provide services and advocacy
that assist people with disabilities to live independently,
become employed and have equality in the communities in which
they live and work. DOR provides consultation, counseling and
vocational rehabilitation, and works with community partners to
assist the consumers they serve.
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.
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.
SUPPORT . The sponsors of this bill, the California Foundation
for Independent Living Centers and Traumatic Brain Injury
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
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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.
PRIOR LEGISLATION . 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.
AB 1794 (Dutra), Chapter 414, Statutes of 2004, extends the TBI
Program until July 1, 2012.
AB 430 (Cardenas), Chapter 171, Statutes of 2001, extends the
TBI Program until July 1, 2007.
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.
AB 3483 (Friedman), Chapter 197, Statutes of 1996, extends the
TBI Program sunset to January 1, 2000.
SB 1457 (Mello), Chapter 508, Statutes of 1992, extends the TBI
Program to January 1, 1997.
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.
SECOND COMMITTEE OF REFERENCE . This bill was previously heard
in the Assembly Health Committee on March 31, 2009, and was
approved on a 7-0 recommend consent vote.
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REGISTERED SUPPORT / OPPOSITION :
Support
American Federation of State, County and Municipal Employees
(AFSCME)
Association of California Caregiver Resource Centers
Betty Clooney Foundation
California Foundation for Independent Living Centers
(Co-sponsor)
California Ski and Snowboard Safety Organization
Central Coast Center for Independent Living (CCCIL
Disabilities Rights California
Making Headway Center for Brain Injury Recovery
Mercy's Coordinated Care Project
San Francisco Traumatic Brain Injury Network (SF TBI Net)
St. Jude Brain Injury Network
The California Disabled Veteran Business Alliance
Traumatic Brain Injury Services of CA (Co-sponsor)
Opposition
None on file.
Analysis Prepared by : Frances Chacon / HUM. S. / (916)
319-2089