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Governor’s Task Force on Traumatic Brain
Injury
TBI Trust Fund and Funding Sources
This is intended to focus discussion on the task which
is set forth in the Governor’s Executive Order 01-02 as follows:
“Explore sources of funding for a TBI
Trust Fund to be used to provide support and assistance to survivors which will help them in their efforts to reclaim their
lives, develop their abilities to function more independently and enable them
to be integrated into and make their contribution to society.”
Discussion Issues:
· Considering a Trust Fund (Review Public Policy Brief
from
· What has been done in other states (Attachment A).
· The most recent Trust Fund legislation passed, June
2002,
· An example of funding sources from citations,
·
Public Policy Brief
from
Evaluating State Traumatic Brain Injury Trust Fund Legislation:
Some Questions to Consider
A number
of States have established trust funds to finance traumatic brain injury (TBI)
services and supports. Some States are actively pursuing and others are
considering TBI trust fund legislation. A number of important issues should be
carefully considered prior to committing to the establishment of a TBI trust
fund. Particularly important is an awareness of potential negative implications
that might arise from the establishment of a trust fund. For example, would a
TBI-only trust fund alienate key stakeholders (e.g., cross-disability
coalitions) whose support will be needed for other initiatives or would a TBI
trust fund limit State appropriations to programs that serve individuals with
TBI and their families?
This
policy brief presents questions TBI stakeholders should address when
considering whether to pursue State trust fund legislation or when developing
and evaluating proposals. Questions have been organized into five categories:
1) Decision Process; 2) Financing; 3) Administration; 4) Functions; and, 5)
Oversight. Decision Process includes questions related to organization,
coalitions, priorities, and responsibility. The section on Financing addresses
matters related to securing and sustaining financial support to meet trust fund
objectives. Administration addresses issues associated with establishing and
operating a program that will ensure excellent customer service and efficient
use of resources. The fourth section, Functions, should help identify the kinds
of services and supports a fund might finance. The final section raises the
important issue of oversight—what oversight mechanisms should be established to
ensure solvency and that resources are used to meet the needs of individuals
with TBI and their families?
Decision
Process
1. What stakeholders (e.g., government,
cross-disability organizations, individuals, and community service providers)
would be involved in evaluating the feasibility of pursuing a trust fund?
2. How and by whom would these stakeholders be
identified?
3. How would decisions be reached (e.g., consensus
agreement)?
4. To whom would the stakeholders report or provide
recommendations?
5. How would the public policy objectives of a trust
fund be identified and prioritized?
6. What information/data would be used to evaluate the
feasibility of developing a trust fund?
7. Would a TBI trust fund alienate some stakeholders
that may be helpful in pursuing other systems changes? If yes, how would this
issue be addressed? If no, how could broader stakeholders help advance a trust
fund proposal?
Financing
1. What would be the source of revenue (e.g., traffic
fines, driving under the influence, State income tax, vehicle license charge)
for the trust fund?
2. Would the trust fund be able to accept private
contributions?
3. Would the funding source(s) be sufficient to meet
needs?
4. How stable/predictable are the funding sources
(i.e., are they tied to a sector of the economy that is subject to
fluctuation)?
5. Would contributions to the trust fund be time
limited?
6. Would the trust fund require periodic
reauthorization by the State legislature?
7. How would trust fund solvency be reviewed/addressed
to ensure services and supports are not cut and that individual and/or family
needs continue to be met?
8. Would a trust fund overtly or covertly result in
resources being diverted away from other TBI/disability programs?
Administration
1. If funded from fines, how would fines be assessed
and collected? Would the contribution to the trust fund be a required
percentage of a certain class of fines or would it be at a court’s discretion?
If the latter, how would court officers be trained/educated about their role in
assessing/collecting penalties for the trust fund?
2. How would the trust fund allocate resources or fund
services? Would the trust fund make an annual contribution to a given State
agency or would individuals apply directly to the trust fund for assistance?
Would the trust fund reimburse approved service providers for costs? How would
the reimbursement schedule be determined and adjusted?
3. How would eligibility be determined?
4. Would the fund be restricted to a specific age or
disability group?
5. Would the application process be cumbersome?
6. What appeals mechanism would be available to
adjudicate disputed claims?
7. What would be the annual administrative costs of
the trust fund and would these costs be paid from the trust fund?
8. Would the trust fund be administered through an
existing program or a new program?
9. What training, technical assistance, education and
outreach would be available to individuals, families, advocates, service
providers, and other stakeholders who would seek to access the trust fund?
10. Would the trust fund operate in a person-centered
or person-directed fashion?
11. Would the trust fund operate in a manner to meet
the unique needs of diverse populations?
12. Could the trust fund be reprogrammed to
provide/finance other State services? If yes, what authority (e.g., approval of
the Governor, agency administrator, trust fund advisory board, or State
legislature) is required?
Functions
1. Would the trust fund support only TBI services and
supports, any services and supports needed by individuals with TBI?
2. What is the purpose of the proposed State trust
fund? For example, would the trust fund cover hospital expenses for the
uninsured, medical rehabilitation, durable medical equipment, cognitive
rehabilitation, employment services, housing assistance, transportation
assistance, assistive technology, respite care, personal attendant services, an
array of services that individuals and families could choose from depending
upon need, support of a State surveillance system, or prevention and public
awareness?
3. Would the trust fund finance the most needed
services, as identified by individuals with TBI, families, and service
providers?
4. What percentage of the State’s population of
individuals with TBI and their families would receive assistance from the trust
fund? Where would those not eligible for trust fund assistance access/finance
services?
Oversight
1. Would the trust fund have an independent advisory
board that includes TBI stakeholders, including individuals with TBI, families,
advocacy organizations and service providers?
2. What would be the relationship between the trust
fund advisory board and the trust fund?
Would the trust fund’s administrator be obligated to listen to/implement
the recommendations of the advisory board?
3. How would members of a trust fund advisory board be
selected/appointed, and for what length of service?
4. What entity will be responsible for auditing the
trust fund?
5. What mechanism will be established to evaluate the
effectiveness of the trust fund in meeting the needs of individuals with TBI
and their families?
Approach to Task Force:
·
How
should the work be divided? Divide
questions among the group? Form separate
sub-groups to answer sub-topics?
·
Should
people from the outside be invited to serve?
·
Would
having guest speakers help?
·
Schedule
Task Group Meetings and create a work plan.
Attachment A
Dedicated Trust Funds for Persons with Brain
and/or Spinal Cord Injuries
|
STATE and YEAR OF INCEPTION |
SOURCES |
FUNDS COLLECTED |
SERVICES PROVIDED |
CONTACT |
1993 |
$100 Fine on DUI convictions |
$1.6 M Annually |
Community based services including: · Pre-vocational · Housing · Respite · Resource coordination · Recreation services |
Administered by: Division of Rehabilitation Services, with oversight by the Impaired Drivers Trust Fund Advisory Board. Department of Rehabilitation Services 35219 (205) 290-4408 |
1992 |
The original legislation instated a $2 fee on speeding, but the system has now moved to a uniform system of surcharges. |
$1.5 M Annually |
Provides: · Rehabilitation services · Research · Education · Prevention |
Administered by: Crystal Snyder Executive Director Governor’s Council on Spinal and Head Injuries (602) 863-0484 |
1986 |
$2 Surcharge on 1st offense seatbelt violations $5 surcharge on second offense |
$500 K Annually |
Provides funding for four pilot programs to demonstrate effectiveness of a coordinated, continuum of care approach to meet the need of adults with brain injuries. |
Administered by: Marita McElwain, Program Manager Department of Mental Health (916)-654-3168 |
|
1988 |
8.2 % on all civil traffic related penalties $60 fine for DUI / BUI $1 on every temporary vehicle license tag |
$13 M Annually |
· Regeneration research · Rehabilitation · Transitional living · Case management |
Administered by: Tom Delilla, Administrator Brain and Spinal Cord Injury Program Phone: (904) 488-8064 |
1998 |
The fund adds 10% on to each DUI issued |
Projected to be $2 million dollars per year at full capacity. |
Not yet determined. |
The legislation gives power to the Brain and Spinal Cord Trust Fund Authority, which is to be appointed by the Governor. The fund is administered by: Department of Human Resources State of |
1998 |
This fund places fines on selected moving violations and drunk driving |
Not yet available. |
Case management, Community Residential Services, Respite, Day Programs, Companion Services, Psychological Services, Prevocational Services, Supported Living and Therapies. |
The bill established a Kentucky Traumatic Brain Injury Trust Fund Board to administer the fund. The legislation outlines who is to be appointed. |
1993 |
$5 fee on reckless driving $15 DUI |
$1.5 M Annually |
To address gaps in services for persons with brain and spinal cord injuries |
Administered by: Don Tubb, Program Manager THI/SCI Trust Fund (225) 925-3502 |
1996 |
$4 on moving violations $25 DUI surcharge |
$2 M Annually |
· Durable medical · Respite · Emergency care · Transitional assistance · Prevention · Education · Transitional living |
Administered by: Department of Rehabilitation Services |
1996 |
$5 fee on a state issued citations |
$ 1.4 M Annually |
Gap and Interim services as needed including: · Durable Medical · Emergency housing · Medications · Therapies · Respite · Transportation · Respite |
Administered by: New Mexico Department of Health Long Term Services Division Hard Runnels Bldg. Phone: (505) 827-2499 |
1993 |
Additional fine for DUI |
$500K-$800K |
Establishes a registry and develops a state plan for a comprehensive system of services. |
Administered by: Jean Doster TBI Program Director Dept of Health Phone: (615)741-1230 |
1989 |
$25 fine on DUI $5 fine on moving violations |
$10 M Annually |
· Equipment · Post acute rehab · Case management |
Administered by: Mel Fajikus, Program Specialist 4900 (512) 424-4133 |
|
1998 |
Annual appropriation made by the Legislature |
Not yet collected. |
· Rehabilitative therapies · Case Management · Attendant care · Home Modifications · Equipment · Family supports |
Administered by: Division of Rehabilitation Services |
For more information
contact:
Brain Injury Association, Inc.
703.236.6000 www.biausa.org
Creating a better future through brain injury
prevention, research, education and advocacy
(Posted: May 2000)
Attachment B:
________
Capital
letters indicate new material added to existing statutes; dashes through words
indicate deletions from existing statutes and such material not part of act.
HOUSE BILL 02-1281
BY REPRESENTATIVE(S) Saliman, Borodkin, Boyd, Coleman, Daniel,
Groff, Hodge, Jahn, Mace, Madden,
Tochtrop, Veiga, Vigil, Weddig, and
Williams S.;
also SENATOR(S) Owen, Dyer, Epps, Hanna, Hernandez, Pascoe,
Perlmutter, Phillips, Tupa,
and Windels.
CONCERNING THE CREATION OF THE
BOARD, AND, IN CONNECTION THEREWITH, INCREASING CERTAIN
MOTOR VEHICLE FINES TO PROVIDE MONEYS FOR THE
TRAUMATIC BRAIN INJURY TRUST FUND.
Be it
enacted by the General Assembly of the State of
SECTION
1. Part 2 of article
1 of title 26, Colorado Revised
Statutes,
is amended BY THE ADDITION
OF THE FOLLOWING NEW SECTIONS to read:
26-1-202.
Definitions. AS USED
IN SECTIONS 26-1-202 TO 26-1-211,
UNLESS THE
CONTEXT OTHERWISE REQUIRES:
(1)
"BOARD" MEANS THE
NOTE: This bill has been prepared for the signature of
the appropriate legislative
officers and the Governor. To determine whether the
Governor has signed the bill
or taken other action on it, please consult the
legislative status sheet, the legislative
history, or the Session Laws.
(2)
"PROGRAM" MEANS THE SERVICES PROVIDED PURSUANT TO
SECTIONS
26-1-204 AND 26-1-205.
(3)
"TRAUMATIC BRAIN INJURY" MEANS INJURY TO THE BRAIN
CAUSED BY
PHYSICAL TRAUMA RESULTING FROM BUT NOT LIMITED TO
INCIDENTS
INVOLVING MOTOR VEHICLES, SPORTING EVENTS, FALLS, AND
PHYSICAL
ASSAULTS. DOCUMENTATION OF TRAUMATIC BRAIN INJURY SHALL BE BASED ON ADEQUATE
MEDICAL HISTORY, NEUROLOGICAL EXAMINATION, INCLUDING MENTAL STATUS TESTING OR
NEUROPHYSICAL EVALUATION. WHERE
APPROPRIATE, NEUROIMAGING MAY BE USED TO SUPPORT THE DIAGNOSIS. A TRAUMATIC
BRAIN INJURY SHALL BE OF SUFFICIENT SEVERITY TO PRODUCE PARTIAL OR TOTAL
DISABILITY AS A RESULT OF IMPAIRED COGNITIVE ABILITY AND PHYSICAL FUNCTION.
(4)
"TRUST FUND" MEANS THE
TRUST FUND
CREATED IN SECTION 26-1-210.
26-1-203.
powers and duties. (1) THERE IS HEREBY CREATED THE
TRAUMATIC
BRAIN INJURY BOARD WITHIN THE DEPARTMENT OF HUMAN
SERVICES. THE
BOARD SHALL EXERCISE ITS POWERS AND DUTIES AS IF
TRANSFERRED
BY A TYPE 2 TRANSFER.
(2) THE
COLORADO TRAUMATIC BRAIN INJURY BOARD SHALL BE COMPOSED OF THIRTEEN MEMBERS
INCLUDING THE EXECUTIVE DIRECTOR OF THE DEPARTMENT OR THE EXECUTIVE DIRECTOR’S
DESIGNEE, THE PRESIDENT OF A STATE BRAIN INJURY ASSOCIATION OR THE PRESIDENT’S
DESIGNEE, THE EXECUTIVE DIRECTOR OF THE DEPARTMENT OF PUBLIC HEALTH AND
ENVIRONMENT OR THE EXECUTIVE DIRECTOR’S DESIGNEE, AND THE FOLLOWING MEMBERS WHO
SHALL BE APPOINTED BY THE GOVERNOR, WITH THE CONSENT OF THE SENATE:
(a) A
NEUROLOGIST WHO HAS EXPERIENCE WORKING WITH PERSONS
WITH
TRAUMATIC BRAIN INJURIES;
(b) A
NEUROPSYCHOLOGIST WHO HAS EXPERIENCE WORKING WITH
PERSONS
WITH TRAUMATIC BRAIN INJURIES;
(c) A
SOCIAL WORKER OR CLINICAL PSYCHOLOGIST EXPERIENCED IN
WORKING
WITH PERSONS WHO HAVE SUSTAINED TRAUMATIC BRAIN INJURIES;
(d) A
REHABILITATION SPECIALIST SUCH AS A SPEECH PATHOLOGIST,
VOCATIONAL
REHABILITATION COUNSELOR, OCCUPATIONAL THERAPIST, OR PHYSICAL THERAPIST WHO HAS
EXPERIENCE WORKING WITH PERSONS WITH TRAUMATIC BRAIN INJURIES;
(e) A
NEUROSURGEON OR NEUROPSYCHIATRIST WHO HAS EXPERIENCE
WORKING
WITH PERSONS WITH TRAUMATIC BRAIN INJURIES;
(f) A
CLINICAL RESEARCH SCIENTIST WHO HAS EXPERIENCE EVALUATING PERSONS WITH
TRAUMATIC BRAIN INJURIES;
(g) TWO
PERSONS WHO ARE FAMILY MEMBERS OF INDIVIDUALS WITH
TRAUMATIC
BRAIN INJURIES OR INDIVIDUALS WITH A TRAUMATIC BRAIN
INJURY;
AND
(h) TWO
MEMBERS OF THE PUBLIC WHO HAVE EXPERIENCE WITH
PERSONS
WITH TRAUMATIC BRAIN INJURIES.
(3) BOARD
MEMBERS SHALL NOT BE COMPENSATED FOR SERVING ON
THE BOARD,
BUT MAY BE REIMBURSED FOR ALL REASONABLE EXPENSES
RELATED TO
SUCH MEMBERS’ WORK FOR THE BOARD.
(4)
INITIAL APPOINTMENTS TO THE BOARD SHALL BE MADE NO LATER
THAN
BE THREE
YEARS; EXCEPT THAT THE TERMS OF THE APPOINTED MEMBERS
WHO ARE
INITIALLY APPOINTED SHALL BE STAGGERED BY THE GOVERNOR TO END AS FOLLOWS:
(a) FOUR
MEMBERS ON
(b) THREE
MEMBERS ON
(c) THREE
MEMBERS ON
(5) NO
MEMBER MAY SERVE MORE THAN TWO CONSECUTIVE TERMS.
(6) THE
APPOINTED MEMBERS OF THE BOARD SHALL, TO THE EXTENT POSSIBLE, REPRESENT RURAL
AND URBAN AREAS OF THE STATE.
(7) THE
BOARD SHALL ANNUALLY ELECT, BY MAJORITY VOTE, A
CHAIRPERSON
FROM AMONG THE BOARD MEMBERS WHO SHALL ACT AS THE PRESIDING OFFICER OF THE
BOARD.
(8) (a)
THE BOARD SHALL PROMULGATE REASONABLE POLICIES AND PROCEDURES PERTAINING TO THE
OPERATION OF THE TRUST FUND.
(b) THE
BOARD MAY CONTRACT WITH ENTITIES TO PROVIDE ALL OR PART OF THE SERVICES
DESCRIBED IN THIS PART 2 FOR PERSONS WITH TRAUMATIC BRAIN INJURIES.
(c) THE
BOARD MAY ACCEPT AND EXPEND GIFTS, GRANTS, AND DONATIONS FOR OPERATION OF THE
PROGRAM.
(9)
ARTICLE 4 OF THIS TITLE SHALL NOT APPLY TO THE
PROMULGATION
OF ANY POLICIES OR PROCEDURES AUTHORIZED BY SUBSECTION (8) OF THIS SECTION.
26-1-204.
Administering entity for services for persons with
traumatic
brain injuries. (1)
AN ADMINISTERING ENTITY UNDER CONTRACT PURSUANT TO SECTION 26-1-203 MAY PERFORM
ALL OR PART OF THE ADMINISTRATIVE, ELIGIBILITY, CASE MANAGEMENT, AND CLAIMS
PAYMENT FUNCTIONS RELATING TO THE PROGRAM, INCLUDING:
(a)
ASSURING TIMELY PAYMENT OF GRANTS OR REQUESTS, INCLUDING:
(I) MAKING
AVAILABLE INFORMATION RELATING TO THE PROPER MANNER OF SUBMITTING A GRANT OR
REQUEST FOR BENEFITS TO THE PROGRAM AND PROVIDING FORMS UPON WHICH SUBMISSIONS
SHALL BE MADE;
(II)
EVALUATING THE ELIGIBILITY OF EACH GRANT OR REQUEST FOR PAYMENT PURSUANT TO
GUIDELINES ESTABLISHED BY THE BOARD;
(III)
NOTIFYING EACH APPLICANT, WITHIN THIRTY DAYS AFTER RECEIVING A PROPERLY
COMPLETED AND EXECUTED PROOF OF GRANT OR REQUEST, WHETHER THE GRANT OR REQUEST IS ACCEPTED OR
REJECTED;
(IV)
ENSURING THAT EACH ACCEPTED GRANT OR REQUEST IS PAID WITHIN FORTY-FIVE DAYS
AFTER ITS ACCEPTANCE;
(b) PAYING
GRANT OR REQUEST EXPENSES FROM THE MONEYS IN THE TRUST FUND; AND (c)
DETERMINING THE EXPENSE OF ADMINISTRATION AND THE PAID
AND
INCURRED LOSSES FOR EACH YEAR AND REPORTING SUCH INFORMATION TO THE BOARD.
(2) THE
ADMINISTERING ENTITY SHALL BE PAID IN COMPLIANCE WITH
POLICIES
AND PROCEDURES ESTABLISHED BY THE BOARD.
(3) IF THE
BOARD DOES NOT CONTRACT WITH AN ADMINISTERING
ENTITY TO
PROVIDE ALL OR PART OF THE SERVICES DESCRIBED IN THIS PART 2 FOR PERSONS WITH
TRAUMATIC BRAIN INJURIES, THE DEPARTMENT SHALL UNDERTAKE TO PROVIDE SUCH
SERVICES TO THE BEST OF ITS ABILITY.
26-1-205.
Services for persons with traumatic brain injuries - limitations - covered
services. (1)
APPROXIMATELY SIXTY-FIVE PERCENT OF THE MONEYS COLLECTED FOR THE TRUST FUND
PURSUANT TO SECTIONS 42-4-1301 (9) (g) (IV) AND 42-4-1701 (4) (e), C.R.S.,
SHALL BE USED TO PROVIDE SERVICES TO PERSONS WITH TRAUMATIC BRAIN INJURIES.
SERVICES PROVIDED PURSUANT TO THIS SECTION SHALL BEGIN TO BE PROVIDED TO
PERSONS WITH TRAUMATIC BRAIN INJURIES NO LATER THAN
(2) TO BE
ELIGIBLE FOR ASSISTANCE FROM THE TRUST FUND, AN
INDIVIDUAL
SHALL HAVE EXHAUSTED ALL OTHER HEALTH OR
REHABILITATION
BENEFIT FUNDING SOURCES THAT COVER THE SERVICES PROVIDED BY THE TRUST FUND. AN INDIVIDUAL
SHALL NOT BE REQUIRED TO EXHAUST ALL PRIVATE FUNDS IN ORDER TO BE ELIGIBLE FOR
THE PROGRAM.
INDIVIDUALS
WHO HAVE CONTINUING HEALTH INSURANCE BENEFITS,
INCLUDING,
BUT NOT LIMITED TO, MEDICAL ASSISTANCE PURSUANT TO
ARTICLE 4
OF THIS TITLE, MAY ACCESS THE TRUST FUND FOR SERVICES THAT ARE NECESSARY BUT
THAT ARE NOT COVERED BY A HEALTH BENEFIT PLAN, AS DEFINED IN SECTION 10-16-102
(21), C.R.S., OR ANY OTHER FUNDING SOURCE.
(3) ALL
INDIVIDUALS RECEIVING ASSISTANCE FROM THE TRUST FUND SHALL RECEIVE CASE
MANAGEMENT SERVICES FROM THE DESIGNATED ENTITY PURSUANT TO SECTION 26-1-204 OR
THE DEPARTMENT.
(4) THE BOARD MAY MONITOR, AND, IF NECESSARY, IMPLEMENT CRITERIA TO ENSURE THAT THERE ARE NO ABUSES IN EXPENDITURES, INCLUDING, BUT NOT LIMITED TO, REASONABLE AND EQUITABLE