BILL ANALYSIS                                                                                                                                                                                                    



                                                                       



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                                 THIRD READING


          Bill No:  AB 398
          Author:   Monning (D), et al
          Amended:  7/23/09 in Senate
          Vote:     21

           
           SENATE HUMAN SERVICES COMMITTEE  :  4-1, 6/23/09
          AYES:  Liu, Maldonado, Alquist, Yee
          NOES:  Runner

           SENATE HEALTH COMMITTEE  :  10-0, 7/15/09
          AYES:  Alquist, Strickland, Aanestad, Cedillo, Cox,  
            DeSaulnier, Leno, Negrete McLeod, Pavley, Wolk
          NO VOTE RECORDED:  Maldonado

           SENATE APPROPRIATIONS COMMITTEE  :  9-0, 8/17/09
          AYES:  Kehoe, Cox, Corbett, Denham, Hancock, Leno, Price,  
            Walters, Yee
          NO VOTE RECORDED:  Oropeza, Runner, Wolk, Wyland
           
          ASSEMBLY FLOOR  :  77-0, 5/21/09 (Consent) - See last page  
            for vote


           SUBJECT  :    Acquired brain trauma:  administration

           SOURCE  :     California Foundation for Independent Living  
          Centers
                      Traumatic Brain Injury Services of California


           DIGEST  :    This bill transfers the administrative duties  
          and oversight of the California traumatic brain injury  
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          program from the Department of Mental Health to the  
          Department of Rehabilitation, and extends the program's  
          sunset date from July 1, 2012 to July 1, 2019.

           ANALYSIS  :    Existing 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  
               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:


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          1. Transfers the administration of the Traumatic Brain  
             Injury Program from DMH to the Department of  
             Rehabilitation (DOR).

          2. 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. 

          3. Directs DOR to use any new funds to provide an array of  
             services to adults with traumatic brain injuries, in  
             areas of the state with the greatest need. 

          4. 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.

          5. 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.

          6. 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.

          7. Directs DOR to monitor and evaluate the performance of  
             service providers.

          8. Requires service providers to furnish uniform data to  
             DOR as necessary to monitor and evaluate the program.

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          9. 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.

          10.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.

          11.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.

          12.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.

          13.Extends the sunset date for the program from July 1,  
             2012 to July 1, 2019.

           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.

           FISCAL EFFECT  :    Appropriation:  No   Fiscal Com.:  Yes    
          Local:  No

          According to the Senate Appropriations Committee:

                          Fiscal Impact (in thousands)

             Major Provisions                2009-10     2010-11     
             2011-12               Fund  

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            DOR administration            $50       $100       
            $100Special*
            of Traumatic Brain
            Injury Program

            * Traumatic Brain Injury Fund

           SUPPORT  :   (Verified  8/19/09)

          California Foundation for Independent Living Centers  
          (co-source) 
          Traumatic Brain Injury Services of California (co-source) 
          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

           ARGUMENTS IN SUPPORT  :    Supporters 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.


           ASSEMBLY FLOOR  :

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          AYES:  Adams, Ammiano, Anderson, Arambula, Beall, Bill  
            Berryhill, Tom Berryhill, Blakeslee, Block, Blumenfield,  
            Brownley, Buchanan, Caballero, Charles Calderon, Carter,  
            Chesbro, Conway, Cook, Coto, Davis, De La Torre, De Leon,  
            DeVore, Duvall, Emmerson, Eng, Evans, Feuer, Fletcher,  
            Fong, Fuller, Furutani, Gaines, Galgiani, Garrick,  
            Gilmore, Hagman, Hall, Harkey, Hayashi, Hernandez, Hill,  
            Huber, Huffman, Jeffries, Jones, Knight, Krekorian, Lieu,  
            Logue, Bonnie Lowenthal, Ma, Mendoza, Miller, Monning,  
            Nestande, Niello, Nielsen, John A. Perez, V. Manuel  
            Perez, Portantino, Price, Ruskin, Salas, Silva, Skinner,  
            Smyth, Solorio, Audra Strickland, Swanson, Torlakson,  
            Torres, Torrico, Tran, Villines, Yamada, Bass
          NO VOTE RECORDED:  Fuentes, Nava, Saldana


          CTW/JJA:nl  8/19/09   Senate Floor Analyses 

                         SUPPORT/OPPOSITION:  SEE ABOVE

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