BILL ANALYSIS
SENATE HEALTH
COMMITTEE ANALYSIS
Senator Elaine K. Alquist, Chair
BILL NO: AB 398
A
AUTHOR: Monning and Chesbro
B
AMENDED: June 30, 2009
HEARING DATE: July 15, 2009
3
CONSULTANT:
9
Tadeo/
8
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.
CHANGES TO EXISTING LAW
Existing law:
Establishes the Department of Mental Health (DMH), which
directs and coordinates statewide efforts for the treatment
of mental health conditions and illnesses.
Establishes the Department of Rehabilitation (DOR) to
provide services and advocacy resulting in employment,
independent living and equality for individuals with
disabilities.
Establishes the Traumatic Brain Injury Program within 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. The program sunsets on July
Continued---
STAFF ANALYSIS OF ASSEMBLY BILL AB 398 (Monning and
Chesbro) Page 2
1, 2012.
Requires DMH to ensure that the Traumatic Brain Injury
Program sites provide or coordinate services to clients,
including supported living, community reintegration
services, vocational supportive services, and information,
referral, and assistance in identifying, accessing,
utilizing, and coordinating all services needed by
individuals with traumatic brain injury and their families.
Establishes the Penalty Fund as a depository for
assessments on specified fines, penalties, and forfeitures
imposed and collected by the courts for specified offenses;
and provides for the distribution of money in the fund.
Establishes the Traumatic Brain Injury Fund, which pays for
the Traumatic Brain Injury Program, and receives a monthly
transfer of 0.66 percent of the Penalty Fund.
Directs the Department of Health Care Services (DHCS), 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:
Transfers the administration of the Traumatic Brain Injury
Program from DMH to DOR.
Defines community rehabilitation program, by citing federal
law, to mean 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, includes, but is not limited to medical, psychiatric,
psychological, social, and vocational services that are
provided under one management, as well as other additional
services.
Directs DOR to use any new funds to provide an array of
services to adults with traumatic brain injuries, in areas
STAFF ANALYSIS OF ASSEMBLY BILL AB 398 (Monning and
Chesbro) Page 3
of the state with the greatest need.
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.
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.
Requires DOR to meet periodically with the 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.
Directs DOR to monitor and evaluate the performance of
service providers.
Requires service providers to furnish uniform data to DOR
as necessary to monitor and evaluate the program.
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.
Requires grants awarded to service providers to be subject
to open competition every three years unless DOR elects to
extend a grant up to two additional years.
Provides a new date of March 15, 2011 for DHCS to submit a
Medicaid waiver application for the services of persons
with a traumatic brain injury.
Clarifies that funds deposited in the Traumatic Brain
Injury Fund may be matched by federal vocational
rehabilitation services funds to the extent the matching
funds are consistent with the policies and priorities of
the department and permitted by other state and federal
laws.
STAFF ANALYSIS OF ASSEMBLY BILL AB 398 (Monning and
Chesbro) Page 4
Eliminates the sunset date for the program and deletes
various sections of code that established the original
program for persons with traumatic brain injury.
FISCAL IMPACT
According to the Assembly Appropriations Committee analysis
of AB 398, DOR can absorb the workload associated with this
bill.
BACKGROUND AND DISCUSSION
According to the author, California is home to 350,000
persons with traumatic brain injury, the highest number of
cases in the nation; and, 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 states that traumatic brain injury is primarily
physical rather than psychological. The author further
states 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. The author contends that DOR, which emphasizes
rehabilitation and independent living, is better suited to
serve these individuals and their families.
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.
Traumatic brain injury
Traumatic brain injury is a cognitive, psychological,
neurological, or anatomical change in brain functions
caused by an external blunt force trauma to the head. Each
year, 22,000 traumatic brain injuries are on record in
California alone.
The Brain Injury Association of America reports that
traumatic brain injury can cause epilepsy and increases the
risk for conditions such as Alzheimer's disease,
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Chesbro) Page 5
Parkinson's disease, and other brain disorders that become
more prevalent with age. In April 2008, the RAND Institute
reported that 320,000 veterans returning from Afghanistan
and Iraq experienced a probable traumatic brain injury
during their deployment.
According to the federal Centers for Disease Control and
Prevention, the leading causes of traumatic brain injury
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.
Traumatic Brain Injury Program
The Traumatic Brain Injury Program was originally created
in 1988 as a three-year program to demonstrate the
effectiveness of a coordinated service approach which
furthers the goal of assisting individuals with traumatic
brain injury to attain productive, independent lives, which
may include paid employment. DMH administers the program
through contracts with community organizations that develop
and operate seven hospital and community-based sites
throughout California. There are four sites operating in
Northern California and three operating in Southern
California.
Berkeley Policy Associates conducted an independent
evaluation of traumatic brain injury services in California
and submitted the report to the Legislature in January,
2005. According to the report, over 100,000 Californians
visit emergency rooms each year due to head injuries, and
an estimated 25 percent of these individuals never return
to work.
According to the report, the typical participant included
in the evaluation's study sample is a 41-year old, single
white male, who has attended some college, receives
Supplemental Security Income or Social Security Disability
Insurance, and either lives alone or with a family member.
Over half of participants were injured in a motor vehicle
accident, and 28 percent of participants' injuries were
related to use of drugs or alcohol, either by the survivor
or another individual. One-quarter of participants had
experienced their traumatic brain injury in the year prior
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Chesbro) Page 6
to enrolling in the program. Overall, however, the average
length of time between injury and intake was ten years.
Three-quarters of all participants were hospitalized as a
result of their traumatic brain injuries, and half
experienced a coma. Over a third of all participants
experienced amnesia after their traumatic brain injuries.
The report also recognized that 610 participants with
moderate to severe impairments from traumatic brain injury
were served in fiscal year 2003-04. Evaluation results
showed that virtually all participants experienced at least
some improvement in community reintegration after enrolling
in the program, with participants at some sites
experiencing substantial changes in their ability to take
care of themselves at home, socialize with friends and
family, and participate in community activities.
Additionally, the program sites provided information and
referral services to 7,000 traumatic brain injury
survivors, caregivers/ family, and professionals across the
state and nation; and, provided education about traumatic
brain injury to more than 2,000 professionals and a similar
number of survivors and their family members in their local
communities.
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 between DMH and DOR. These programs provide a
variety of services including vocational assessment;
personal, vocational, social and work adjustment;
employment preparation; job development and placement; and,
job coaching.
Prior legislation
AB 1410 (Feuer), Chapter 676, Statutes of 2007, requires
DHCS 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 traumatic
brain injuries.
AB 1794 (Dutra), Chapter 414, Statutes of 2004, extends the
Traumatic Brain Injury Program sunset to July 1, 2012.
AB 430 (Cardenas), Chapter 171, Statutes of 2001, extends
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Chesbro) Page 7
the Traumatic Brain Injury Program sunset to July 1, 2007.
AB 1492 (Thomson), Chapter 1023, Statutes of 1999, extends
the Traumatic Brain Injury Program sunset to January 1,
2005, and authorizes its expansion from four to seven sites
to the extent funds are available.
AB 3483 (Friedman), Chapter 197, Statutes of 1996, extends
the Traumatic Brain Injury Program sunset to January 1,
2000.
SB 1457 (Mello), Chapter 508, Statutes of 1992, extends the
Traumatic Brain Injury Program sunset to January 1, 1997.
SB 2232 (Seymour), Chapter 1292, Statutes of 1988,
establishes 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.
Arguments in support
The sponsors and proponents of AB 398 argue 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. Sponsors and proponents
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 program 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 ACTIONS
Senate Human Services: 4-1
Assembly Floor: 77-0
Assembly Appropriations: 16-0
Assembly Human Services: 7-0
Assembly Health: 19-0
POSITIONS
STAFF ANALYSIS OF ASSEMBLY BILL AB 398 (Monning and
Chesbro) Page 8
Support: California Foundation for Independent Living
Centers (sponsor)
San Francisco Traumatic Brain Injury Network
(sponsor)
Traumatic Brain Injury Services of CA (sponsor)
American Federation of State, County and
Municipal Employees
Betty Clooney Foundation
California Association for Adult Day Services
California Brain Injury Association
California Disabled Veterans Business
Alliance
California Ski and Snowboard Safety
Organization
Central Coast Center for Independent Living
Disabilities Rights California
Making Headway Center for Brain Injury Recovery
Oppose: None received
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