1. TBI State and
Federal Policy
Overview

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

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

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

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

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

7. 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”
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.

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

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

10. 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.

11. 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

12. 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.

13. 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 The Children’s Health Act of 2000 (P.L ) is a compilation of many different bills, both new and existing, that amended the Public Health Service Act with respect to children’s health.

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

15. 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