Traumatic Brain Injury Educational Series Presented by Telehealth Idaho Balancing Budgets, Advancing Outcomes: The Public/Private Partnership in Brain Injury Service Delivery - PowerPoint PPT Presentation

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Traumatic Brain Injury Educational Series Presented by Telehealth Idaho Balancing Budgets, Advancing Outcomes: The Public/Private Partnership in Brain Injury Service Delivery

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Title: Developing State Capacity: Update on Federal Legislation & National Initiatives Author: Susan H. Connors Last modified by: Susan H. Connors – PowerPoint PPT presentation

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Title: Traumatic Brain Injury Educational Series Presented by Telehealth Idaho Balancing Budgets, Advancing Outcomes: The Public/Private Partnership in Brain Injury Service Delivery


1
Traumatic Brain Injury Educational
SeriesPresented by Telehealth Idaho Balancing
Budgets, Advancing Outcomes The Public/Private
Partnership in Brain Injury Service Delivery
Susan H. Connorswww.nashia.org
2
NASHIAs Mission
To assist state government in promoting
partnerships and building systems to meet the
needs of individuals with brain injury and their
families.
3
NASHIA Activities
  • Information - Fact Sheets, National Directory,
    News Bulletins, JHTR Articles
  • Education - Annual Meeting, Web Casts, Speakers
    Bureau
  • Communication - Task Forces, Web Site, Exhibiting
    Outreach
  • Collective Representation - Congress, Federal
    Agencies, National Organizations

4
TBI Incidence Prevalence
  • 1.5 million/yr injured
  • 1 million/yr seek emergency treatment
  • 230,000/yr hospitalized
  • 50,000/yr die
  • 80,000/yr result in permanent disability

CDC figures as of Jan 2001
  • 5.3 million Americans with TBI disability

5
GAO Report
As families exhaust their resources, the public
sector pays for a greater share of the services
received.
TBI Programs Supporting Long-Term Services in
Selected States (HEHS-98-55)
6
Key Federal Policies
  • 1935 - Social Security Act
  • 1954 - Vocational Rehabilitation Act
  • 1975 - Education for All Handicapped Children Act
    (Individuals with Disabilities Education Act)
  • 1975 - Developmental Disabilities Assistance and
    Bill of Rights Act
  • 1981 - Omnibus Budget Reconciliation Act
  • 1990 - Americans with Disabilities Act
  • 1999 - Ticket to Work and Work Incentives
    Improvement Act

7
TBI Act
TBI Act of 1996 (PL 104-166) TBI Act Amendments
(Title XIII of Childrens Health Act of 2000, PL
106-310)
  • to provide for the conduct of expanded studies
    and the establishment of innovative programs with
    respect to traumatic brain injury and for other
    purposes.

8
NASHIAs Study
  • Definitions

93 Questions on State Government Brain Injury
Policies, Funding Services
  • Data Collection
  • Lead Agencies
  • Advisory Councils
  • Collaboration
  • Funding Streams
  • Services Supports

9
Systems of Care
10
Definitions
TBI
ABI
Both
11
Lead Agencies
  • Functions Plan, Administer Programs, Manage
    Funds, Collaborate, Support Council
  • Clusters in
  • Health (20 states)
  • Developmental Disabilities (6)
  • Rehabilitation (6)
  • Mental Health (5)
  • Human Services (5)
  • 21 by Statute 3 by Executive Order

12
Advisory Boards/Councils
  • 47 of 51 States have advisory councils
  • 41 of 47 have staff
  • 20 in statute, 6 by exec order
  • 13 report to governor or legislature
  • Board size ranges 9-54 people avg 20-25
  • 40 consumer 35 state agency employees
  • 36 have chairpersons (majority are elected)

13
Advisory Council Functions
  • Involved in planning, education, systems
    coordination, rehab long-term services,
    prevention, and advise on funding
  • Produce assessment, action plan, annual reports,
    legislative recommendations, info brochures

14
Services/Supports
  • Eligibility Requirements
  • Injury Severity
  • Age
  • Asset/Income Limitations
  • Parameters
  • Scope
  • Duration
  • Frequency
  • Annual Lifetime Caps

15
Services/Supports
  • Assessment/Evaluation 46 states
  • Behavioral Programs/Services 41 states
  • Case Management/Svc Coord 46 states
  • Community/Family Education 33 states
  • Housing Subsidies 13 states
  • Long-term Residential Services 35 states
  • Pre-vocational Services 35 states
  • Respite 45 states
  • Supported Employment 37 states
  • Substance Abuse Services 33 states
  • Therapy, Cognitive 33 states
  • Transportation 45 states
  • Vocational Services 16 states
  • Other Services 23 states

16
Funding Mechanisms
  • State Medicaid Plan 51 states
  • Federal Block Grants 51 states
  • Medicaid Waivers 47 states
  • TBI Medicaid Waiver 25 states
  • Trust Fund 18 states
  • General Revenue 22 states
  • Special Revenue 4 states

17
Medicaid Waivers
  • 1981 Omnibus Budget Reconciliation Act
  • Lead to creation of 1915(c) Home and Community
    Based Services
  • HCBS Waivers serving individuals with brain
    injury
  • Developmental Disabilities 31 States
  • Aging Disabled 25 States
  • Physical Disabilities 12 States
  • Elderly 10 States

18
TBI HCBS Waivers
19
TBI HCBS Waiver Services
  • Assessment

Some Pay For
  • Behavioral Programs
  • Case Management
  • Residential
  • Companion/Homemaker Services
  • Respite
  • Day Services
  • Pre-Vocational
  • Durable Medical Equipment
  • Vocational
  • Environmental Modifications
  • Life Skills Training
  • Personal Care Attendants
  • Substance Abuse Services
  • Therapies
  • Transportation

20
Trust Funds
  • Legislation to create dedicated funding
  • Usually from fees, fines, or surcharges
  • Requires agency administration and advisory
    council oversight
  • Often rules on eligibility, scope, amount, and
    duration of services including caps
  • Can provide menu of services designed to fill
    gaps
  • 18 States 8 serving TBI (usually ABI or SCI)
  • 3 million average fund size

21
Trust Funds
22
Trust Fund Services
Assistive Technology 11
Environmental Mods 9
Community/Family Education 11
Ind Living Skills 9
Spec Med Equip 9
Cognitive Therapy 11
Behavioral Programs 8
Occupational Therapy 11
Personal Care 8
Physical Therapy 11
Recreation 8
Case Management 10
Respite 8
Speech Therapy 10
Support Groups 8
Assessment/Evaluation 10
Vehicle Modifications 8
Day Services (Social Model) 9
23
General Special Revenue
General
Special
Both
24
General Special Rev Uses
  • Services 19 states
  • Policy/Planning 7 states
  • Prevention 3 states
  • Registry 2 states
  • Research 1 state
  • Other 12 states

25
Funding Combinations
26
Combinations Key
Waiver
Waiver, TBI Waiver Appropriation
Waiver TBI Waiver
Waiver, TBI Waiver Trust Fund
Waiver Appropriation
Waiver, Appropriation Trust Fund
Waiver, TBI, Appropriation Trust Fund
Waiver Trust Fund
Appropriation Trust Fund
27
Lessons Learned
  • Data drives policy.
    Allan Bergman, BIA of America

Policy drives funding. Betty
Hastings, MCHB
Funding drives services. NASHIA
members
Advocates Drive The System.
28
Thanks!
  • Susan H. Connors
  • Executive Director
  • National Association of State Head Injury
    Administrators
  • 4733 Bethesda Ave., Suite 330
  • Bethesda, MD 20814
  • 301-320-4331
  • shconnors_at_nashia.org
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