TBI State and Federal Policy Overview

Advocacy Brain Injury Association of America National and State (formerly National Head Injury Foundation) National and State OSERS/Vocational Rehabilitation Congress/State Legislators

Barriers to Services Lack of Information Eligibility Complexity of Needs Lack of Expertise Lack of Services & Providers Lack of Funding for TBI Services

State Efforts State Funded TBI Rehab Units Registries Beginning in the 1980s . . . State Funded TBI Rehab Units Registries Linkages, Surveillance Advisory Councils/Boards

State Efforts State TBI Services/Lead Agencies State Appropriations Trust Funds, Dedicated Funding Expanded Existing Programs VR, DD, Medicaid

Injury In America: A Continuing Public Health Problem Surveillance Research EMS, Acute Care & Rehab Research Injury Prevention Link individuals to services CDC’s Role . . . 1985

Federal Interagency Task Force Recommendations: Establish "traumatic brain injury" as a category in reporting systems Designate a lead Federal agency State and local “working groups” --1989 Report In 1987, the U.S. House of Representatives Committee on Appropriations called upon the Department of Health and Human Services to establish an Interagency Head Injury Task Force. In 1988, the National Institute of Neurological Disorders and Stroke, National Institutes of Health convened the Task Force, and issued a report in February 1989, . The report recommended six actions that would represent the core of a national strategy for dealing with brain injury.

A national network of regional research centers A decentralized system of care Study and document the financial issues societal cost and related economic impact --1989 Report

Federal Efforts US Department of Education -- NIDRR Model Systems (1987) -- NIDRR Research Training Centers (1987) -- RSA Regional Grants (1989-1996) IDEA (1990)

Introduction of TBI Act (1991) Prevention Proposed marketing standards Practice guidelines Outcome studies State grants The Federal Medicaid agency, CMS (HCFA at that time) worked with States to develop a prototype for a TBI Home and Community-Based Medicaid Waiver. Kansas was the first State to implement a HCB waiver, and other States followed—although not all used the prototype. In 1990, the special education act was reauthorized (IDEA) and included TBI as a disability category for purposes of reporting the various categories of individuals with disabilities receiving special education services. TBI legislation was filed initially by Senator Edward Kennedy in 1991.

TBI Act of 1996 Changed language for State Grant HRSA was specifically designated Changed language for State Grant Program Required State cash match ($1 State for every $2 Federal) In February 1994, Kennedy introduced S. 725 that contained substantial amendments to the earlier proposals. In this legislation:   HRSA was specifically designated as the granting agency for State programs Most of the prescriptive language for the grant program was removed A State cash match requirement was introduced: $1 State for every $2 Federal

TBI Act of 1996 (PL 104-66) Prevention & Data -- Consensus Conference CDC Prevention & Data NIH -- Consensus Conference HRSA -- State Grant Program The law authorized funding to these agencies to carry out the functions.

Traumatic Brain Injury 2000 P.L. 106-310 Definition Expanded surveillance Soft Match Role of Individual in Service Delivery Added P&A Program The TBI Act was reauthorized in 2000 as Title XIII of the Children’s Health Act of 2000. The Children’s Health Act of 2000 (P.L. 106-310) is a compilation of many different bills, both new and existing, that amended the Public Health Service Act with respect to children’s health.

Emerging Trends and Issues Emphasis on Community Supports -- “Olmstead Decision” Aging Caregivers Limited Fiscal Resources Sustainability of Efforts

Proposed TBI Act of 2005 May eliminate State match (soft) HRSA State Grant Program May eliminate State match (soft) Formula-based Add American Indian Consortium