Traumatic Brain Injury Educational Series Presented by Telehealth Idaho Balancing Budgets, Advancing...
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![Page 1: Traumatic Brain Injury Educational Series Presented by Telehealth Idaho Balancing Budgets, Advancing Outcomes: The Public/Private Partnership in Brain.](https://reader038.fdocuments.in/reader038/viewer/2022110320/56649ca35503460f9496382c/html5/thumbnails/1.jpg)
Traumatic Brain Injury Educational Series
Presented by Telehealth Idaho
Balancing Budgets, Advancing Outcomes:
The Public/Private Partnership in Brain Injury Service Delivery
Susan H. Connors
www.nashia.org
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NASHIA’s Mission
To assist state government in promoting partnerships and building systems to
meet the needs of individuals with brain injury
and their families.
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NASHIA ActivitiesInformation - 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
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5.3 million Americans with TBI disability
• 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
TBI Incidence & Prevalence
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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)
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Key Federal Policies
1935 - Social Security Act1954 - Vocational Rehabilitation Act1975 - Education for All Handicapped
Children Act (Individuals with Disabilities Education Act)
1975 - Developmental Disabilities Assistance and Bill of Rights Act
1981 - Omnibus Budget Reconciliation Act1990 - Americans with Disabilities Act1999 - Ticket to Work and Work Incentives
Improvement Act
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TBI Act
“…to provide for the conduct of expanded studies and the establishment of innovative programs with respect to traumatic brain injury and for other purposes.”
TBI Act of 1996 (PL 104-166)TBI Act Amendments (Title XIII of Children’s
Health Act of 2000, PL 106-310)
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NASHIA’s Study
• Definitions• Data Collection• Lead Agencies• Advisory Councils
• Funding Streams• Services & Supports
• Collaboration
93 Questions on State
Government Brain Injury
Policies, Funding & Services
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Systems of Care
Prevention
RESEARCH
Traum
a
Pre-Hospital,
Emergency Medical Services
Emergency Department
Acute Care
InpatientRehabilitation
COMMUNITY
Out Patient Rehab
Education
Family Support Services
Housing
Vocational Training/Employment
Long Term Services and Supports
Physicians
CASE MANAGEMENT/SERVICE COORDINATION
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Definitions
TBI ABI Both
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Lead AgenciesFunctions – 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
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Advisory Boards/Councils47 of 51 States have advisory councils41 of 47 have staff 20 in statute, 6 by exec order13 report to governor or legislatureBoard size ranges 9-54 people; avg 20-2540% consumer; 35% state agency
employees 36 have chairpersons (majority are elected)
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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
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Services/SupportsEligibility Requirements
– Injury Severity– Age– Asset/Income Limitations
Parameters– Scope– Duration– Frequency– Annual & Lifetime Caps
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Services/SupportsAssessment/Evaluation – 46 statesBehavioral Programs/Services – 41 statesCase Management/Svc Coord – 46 statesCommunity/Family Education – 33 statesHousing Subsidies – 13 statesLong-term Residential Services – 35 statesPre-vocational Services – 35 statesRespite – 45 statesSupported Employment – 37 statesSubstance Abuse Services – 33 statesTherapy, Cognitive – 33 statesTransportation – 45 statesVocational Services – 16 statesOther Services – 23 states
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Funding Mechanisms
State Medicaid Plan – 51 statesFederal Block Grants – 51 statesMedicaid Waivers – 47 statesTBI Medicaid Waiver – 25 statesTrust Fund – 18 statesGeneral Revenue – 22 statesSpecial Revenue – 4 states
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Medicaid Waivers1981 Omnibus Budget Reconciliation ActLead to creation of 1915(c) – Home and
Community Based ServicesHCBS Waivers serving individuals with
brain injury:• Developmental Disabilities – 31 States • Aging & Disabled – 25 States• Physical Disabilities – 12 States • Elderly – 10 States
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TBI HCBS Waivers
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TBI HCBS Waiver Services•Assessment
•Behavioral Programs•Case Management•Companion/Homemaker Services•Day Services
•Durable Medical Equipment
•Environmental Modifications•Life Skills Training•Personal Care Attendants
•Substance Abuse Services
•Therapies•Transportation
•Vocational
Some Pay For: •Residential
•Respite
•Pre-Vocational
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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
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Trust Funds
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Trust Fund ServicesEnvironmental Mods – 9Assistive Technology –
11 Community/Family Education – 11
Cognitive Therapy – 11
Occupational Therapy – 11Physical Therapy – 11
Case Management – 10
Assessment/Evaluation – 10
Speech Therapy – 10
Day Services (Social Model) – 9
Ind Living Skills – 9
Behavioral Programs – 8
Spec Med Equip – 9
Personal Care – 8
Recreation – 8
Respite – 8
Support Groups – 8Vehicle Modifications – 8
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General & Special Revenue
General
Special
Both
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General & Special Rev Uses
Services – 19 statesPolicy/Planning – 7 statesPrevention – 3 statesRegistry – 2 statesResearch – 1 stateOther – 12 states
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Funding Combinations
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Combinations Key
Waiver Waiver, TBI Waiver & Appropriation
Waiver, TBI Waiver & Trust FundWaiver & TBI WaiverWaiver & AppropriationWaiver & Trust Fund
Waiver, TBI, Appropriation & Trust Fund
Waiver, Appropriation & Trust Fund
Appropriation & Trust Fund
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Lessons Learned“Data drives policy.”
Allan Bergman, BIA of America
“Policy drives funding.” Betty Hastings, MCHB
“Advocates Drive The System.”
“Funding drives services.”
NASHIA members
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Thanks!
Susan H. ConnorsExecutive DirectorNational Association of State Head
Injury Administrators4733 Bethesda Ave., Suite 330Bethesda, MD [email protected]