Title: Traumatic Brain Injury Educational Series Presented by Telehealth Idaho Balancing Budgets, Advancing Outcomes: The Public/Private Partnership in Brain Injury Service Delivery
1Traumatic 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
2NASHIAs Mission
To assist state government in promoting
partnerships and building systems to meet the
needs of individuals with brain injury and their
families.
3NASHIA 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
4TBI 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
5GAO 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)
6Key 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
7TBI 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.
8NASHIAs Study
93 Questions on State Government Brain Injury
Policies, Funding Services
9Systems of Care
10Definitions
TBI
ABI
Both
11Lead 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
12Advisory 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)
13Advisory 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
14Services/Supports
- Eligibility Requirements
- Injury Severity
- Age
- Asset/Income Limitations
- Parameters
- Scope
- Duration
- Frequency
- Annual Lifetime Caps
15Services/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
16Funding 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
17Medicaid 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
18TBI HCBS Waivers
19TBI HCBS Waiver Services
Some Pay For
- Companion/Homemaker Services
- Durable Medical Equipment
- Environmental Modifications
20Trust 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
21Trust Funds
22Trust 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
23General Special Revenue
General
Special
Both
24General Special Rev Uses
- Services 19 states
- Policy/Planning 7 states
- Prevention 3 states
- Registry 2 states
- Research 1 state
- Other 12 states
25Funding Combinations
26Combinations 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
27Lessons Learned
- Data drives policy.
Allan Bergman, BIA of America
Policy drives funding. Betty
Hastings, MCHB
Funding drives services. NASHIA
members
Advocates Drive The System.
28Thanks!
- 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