BILL ANALYSIS
SENATE HUMAN
SERVICES COMMITTEE
Senator Carol Liu, Chair
BILL NO: AB 398
A
AUTHOR: Monning
B
VERSION: June 16, 2009
HEARING DATE: June 23, 2009
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FISCAL: To Health and to Appropriations
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8
CONSULTANT:
Hailey
SUBJECT
Acquired brain trauma: administration
SUMMARY
Transfers the administrative duties and oversight of the
California traumatic brain injury program from the
Department of Mental Health to the Department of
Rehabilitation, and deletes the program's sunset date.
ABSTRACT
Current law
1)Establishes the traumatic brain injury program within the
State Department of Mental Health (DMH) and requires the
department to designate project sites for a system of
post-acute continuum-of-care models for adults with
traumatic brain injury.
2)Sunsets the program on July 1, 2012.
3)Requires DMH to ensure the project sites provide or
coordinate services to clients, including supported
living, community reintegration services, vocational
supportive services, and information, referral, and
Continued---
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assistance in identifying, accessing, utilizing, and
coordinating all services needed by individuals with
traumatic brain injury and their families.
4)Establishes the state penalty fund as a depository for
assessments on specified fines, penalties, and
forfeitures imposed and collected by the courts for
specified offenses; provides for distribution of money in
the fund.
5)Establishes the traumatic brain injury fund, which
receives a monthly transfer of 0.66 percent of the state
penalty fund, and which pays for the traumatic brain
injury program.
6)Directs the Department of Health Care Services, by March
15, 2009, to submit a home- and community-based services
waiver application to the federal Centers for Medicare
and Medicaid Services to serve at least 100 adults, who
have an acquired traumatic brain injury, utilizing
rehabilitative therapies in lieu of a nursing facility or
an intermediate care facility for persons with
developmental disabilities.
This bill
1) Transfers the administration of the traumatic brain
injury program from DMH to the State Department of
Rehabilitation (DOR).
2) Defines "community rehabilitation program" by citing
federal law that reads, in part, "a program that
provides directly or facilitates the provision of
vocational rehabilitation services to individuals with
disabilities, and that provides, singly or in
combination, for an individual with a disability to
enable the individual to maximize opportunities for
employment, including career advancement" and an
additional list of services. (29 USC Section 705)
3) Directs DOR to use any new funds to provide an array of
services, in those areas of the state with greatest
need, to adults with traumatic brain injuries.
4) Strikes various sections of code that established the
original program for persons with traumatic brain
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injury.
5) Requires DOR, by January 1, 2012, to determine
requirements related to service delivery, data
collection, and other aspects of program administration
that service providers must meet.
6) Requires DOR, by January 1, 2013, to determine the level
of funding necessary for a service provider to serve its
designated area, determine the number of sites that
current funding can support, and solicit applications to
provide services.
7) Requires DOR to meet periodically with traumatic brain
injury program service providers to discuss performance
standards and data collection, eligibility requirements,
refinement of the continuum of care, and, if approved by
the federal government, implementation of a Medicaid
waiver.
8) Directs DOR to monitor and evaluate the performance of
service providers.
9) Requires service providers to furnish uniform data to
DOR as necessary to monitor and evaluate the program.
10)Requires that providers continuing to participate in the
program after July 1, 2013, be in compliance with
requirements that DOR establishes pursuant to this act.
11)Determines that grants awarded to service providers be
subject to open competition every three years with the
proviso that DOR can elect to extend a grant up to two
additional years.
12)Provides a new date of March 15, 2011, for the
Department of Health Care Services to submit a Medicaid
waiver application for the services of persons with a
traumatic brain injury
13)Eliminates the sunset date for the program.
Note: the author has agreed, at the request of DOR, to
amend the bill at a future date to combine two sections of
the bill: the section of findings and declarations (Welfare
STAFF ANALYSIS OF ASSEMBLY BILL 398 (Monning) Page
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and Institutions Code Section 4354.5) and the section
directing the department to pursue all available funding,
to fund an array of services, and to do so within a
coordinated service delivery system (WIC Section 4354.6).
Committee staff believe this would be a technical
amendment.
FISCAL IMPACT
The Assembly Appropriations Committee believes that DOR can
absorb the workload associated with this bill.
BACKGROUND AND DISCUSSION
Purpose of the bill
According to the author, California is home to 350,000
persons with traumatic brain injury. Men and women in the
armed services, returning from conflicts in Afghanistan and
Iraq, with traumatic brain injuries, are adding to that
number. The author says that the injury is primarily
physical rather than psychological. The author believes
that DMH lacks the personnel, issue area expertise, and the
core mission to address the myriad physical injuries and
symptoms that constitute traumatic brain injury. DOR,
which emphasizes rehabilitation and independent living, is
better suited to serve these 350,000 individuals and their
families.
Background
Traumatic brain injury results from 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 are
falls, motor vehicle-traffic crashes, 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 percent of them do not return to work. To
address the needs of this population, the Legislature
created the traumatic brain injury program in 1990 to
coordinate services for adults with these injuries. DMH
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administers the program through contracts with community
organizations that develop and operate seven hospital- and
community-based sites through California. The project
sites provide services such as community reintegration,
family and community education, supported living,
vocational supports, and service coordination.
DOR administers the largest vocational rehabilitation
program in the country. It provides services and advocacy
to assist people with disabilities to live independently,
become employed, and have equality in the communities in
which they live and work. The department provides
consultation, counseling and vocational rehabilitation, and
works with community partners to assist the consumers they
serve.
Interagency agreements
In 1998, DMH and DOR worked together to develop vocational
rehabilitation programs specifically focused on the needs
of adults with traumatic brain injury. Currently, three of
the seven program sites participate in the interagency
agreement with between DMH and DOR. These 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.
Arguments in support
The sponsors of this bill 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
persons with traumatic brain injury need to achieve
independent living. They point out that DOR administers
the state's independent living centers, which are designed
to maximize options for independence for persons with
disabilities. Several of the current project sites as well
as the Disabled Veterans Business Alliance state that DOR's
focus on rehabilitation makes it a better fit for the needs
of persons with traumatic brain injury.
Prior legislation
AB 1410 (Feuer), Chapter 676, Statutes of 2007, requires
the Department of Health Care Services to submit a home-
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and community-based federal Medicaid waiver application or
state plan amendment by March 15, 2009, to serve at least
100 adults with acquired traumatic brain injuries.
AB 1794 (Dutra), Chapter 414, Statutes of 2004, extended
the traumatic brain injury program until July 1, 2012.
AB 430 (Cardenas), Chapter 171, Statutes of 2001, extended
the program until July 1, 2007.
AB 1492 (Thomson), Chapter 1023, Statutes of 1999, extended
the 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 program's sunset to January 1, 2000.
SB 1457 (Mello), Chapter 508, Statutes of 1992, extended
the program to January 1, 1997.
SB 2232 (Seymour), Chapter 1292, Statutes of 1988,
established the three-year traumatic brain injury program
within DMH and directs DMH to fund project sites that
provide the array of services and assistance to individuals
and their families.
Prior Assembly votes
Floor: 77-0
Appropriations:16-0
Human Services: 7-0
Health: 19-0
COMMENTS AND QUESTIONS
Changing the administering agency and the monitoring
The program has always operated via grants and contracts,
rather than DMH providing direct services. Recent
amendments to the bill require DOR to establish uniform
data collection and evaluation practices across all
grantees and to make the grants competitive every three
years. The committee may want to ask the author if there
have been problems with the program. Does it need
direction it is not currently receiving?
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Making the program permanent
The program was established 20 years ago. The Legislature
has extended the program's sunset date five times. This
bill removes any sunset, making the program permanent. The
program has received evaluations, which are available
on-line at:
http://www.dmh.ca.gov/Services_and_Programs/Adults/TBI.asp
The committee may want to ask the author to describe the
evidence that the program fulfills its intent, thus
justifying removing the program's sunset.
POSITIONS
Support: California Foundation for Independent Living
Centers (sponsor)
Traumatic Brain Injury Services of CA
(sponsor)
American Federation of State, County and
Municipal Employees
Association of California Caregiver Resource
Centers
Betty Clooney Foundation
California Association for Adult Day
Services
California Brain Injury Association
California Ski and Snowboard Safety
Organization
Central Coast Center for Independent Living
Disabilities Rights California
Making Headway Center for Brain Injury
Recovery
Mercy's Coordinated Care Project
San Francisco Traumatic Brain Injury Network
St. Jude Brain Injury Network
The California Disabled Veteran Business
Alliance
Oppose: None received
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