TBI Trust Fund

Creates traumatic brain injury trust fund commission/trust fund
to disburse moneys to applicants for care and rehabilitative
services for traumatic brain injury victims.  Appropriates money
for the trust fund. (SD1)

HOUSE OF REPRESENTATIVES                H.B. NO.           H.D. 2
TWENTIETH LEGISLATURE, 2000                                S.D. 1
STATE OF HAWAII                                            

                   A  BILL  FOR  AN  ACT



 1      SECTION 1.  The legislature finds that every year 1.9
 2 million Americans experience traumatic brain injury.  About half
 3 of these cases result in short-term disability.  Of traumatic
 4 brain injury survivors, seventy thousand to ninety thousand
 5 endure lifelong debilitating losses of function.
 6      Traumatic brain injury is defined as an injury to the brain
 7 that is not degenerative or inherited and that is caused by an
 8 external physical force that produces a diminished or altered
 9 state of consciousness, which results in an impairment of
10 cognitive abilities or physical functioning, and disturbances of
11 behavioral and emotional functioning.
12      The legislature further finds that physical consequences of
13 brain injury include impairment of speech, vision and hearing
14 loss, headaches, muscle spasticity, paralysis, and seizure
15 disorders.  Cognitive consequences of brain injury include memory
16 deficit, limited concentration, impaired perception and
17 communication, and difficulties with reading, writing, planning,
18 and judgment.  Psychosocial-behavioral-emotional consequences of
19 brain injury include fatigue, mood swings, denial, anxiety,
20 depression, lack of motivation, and decreased social skills.

Page 2                                                     2160
                                     H.B. NO.           H.D. 2
                                                        S.D. 1

 1      Advances in neurosurgery and rehabilitation therapy have
 2 dramatically increased the number of individuals who survive
 3 traumatic brain injury and have made the hope of returning to the
 4 community more realistic.  However, little has been done to
 5 assist traumatic brain injury survivors to adjust to life after
 6 the injury.  The average medical cost for a three- to six-month
 7 initial hospitalization for traumatic brain injury is $75,000.
 8 The survivor of a severe brain injury typically faces five to ten
 9 years of intensive treatment at an estimated cost in excess of
10 $4,000,000.  Nationally, the direct medical costs for treatment
11 of traumatic brain injury have been estimated at more than
12 $4,000,000,000 per year.  The total economic costs of brain
13 injury have been estimated to approach $25,000,000,000 per year.
14      In Hawaii, the Hawaii health systems corporation estimates
15 that twelve hundred people are discharged annually from Hawaii's
16 hospitals with traumatic brain injury.  Currently, Hawaii lacks a
17 system that provides, manages, and monitors services for
18 individuals with traumatic brain injuries, and effective and
19 affordable treatment and rehabilitation programs are not
20 available.  Support programs for family members and caregivers
21 are also lacking.
22      The purpose of this Act is to establish a dedicated trust
23 fund to help defray the costs of treating brain injuries.

Page 3                                                     2160
                                     H.B. NO.           H.D. 2
                                                        S.D. 1

 1      SECTION 2.  The Hawaii Revised Statutes is amended by adding
 2 a new chapter to be appropriately designated and to read as
 3 follows:
 4                             "CHAPTER
 6         -1 Definitions.  As used in this chapter, unless the
 7 context requires otherwise:
 8      "Commission" means the traumatic brain injury trust fund
 9 commission.
10      "Trust fund" means the traumatic brain injury trust fund.
11         -2 Traumatic brain injury trust fund commission;
12 established.(a)  There is established the traumatic brain
13 injury trust fund commission which shall be placed within the
14 department of health for administrative purposes only.  The
15 commission shall be headed by a board of directors.
16      (b)  The board shall consist of nine members who shall be
17 appointed by the governor in accordance with section 26-34.  The
18 members shall be as follows:
19      (1)  The director of health, or designee, as a member ex
20           officio;
21      (2)  The director of human resources, or designee, as a
22           member ex officio;
23      (3)  The superintendent of education, or designee, as a

Page 4                                                     2160
                                     H.B. NO.           H.D. 2
                                                        S.D. 1

 1           member ex officio;
 2      (4)  Three individuals who have sustained brain or spinal
 3           cord injury or members of the immediate families of
 4           individuals who have sustained brain or spinal cord
 5           injury; and
 6      (5)  Three members nominated by the Hawaii Medical
 7           Association who have experience in rehabilitation of
 8           victims of traumatic brain injury.
 9      (c)  Except for ex officio members, members shall serve for
10 a term of two years, except that of the members initially
11 appointed under paragraphs (4) and (5), two members shall serve
12 for three years, two members shall serve for two years, and two
13 members shall serve for one year.
14      (d)  The director of health shall serve as chairperson.  The
15 members shall elect from among themselves a vice chairperson and
16 treasurer.
17      (e)  A member whose term has expired may continue in office
18 as a holdover member until a successor is elected; provided that
19 the holdover shall not hold office beyond the end of the second
20 regular legislative session following the expiration of the
21 member's term.
22      (f)  Vacancies occurring before the expiration of a member's
23 term shall be filled in the same manner as the original

Page 5                                                     2160
                                     H.B. NO.           H.D. 2
                                                        S.D. 1

 1 appointments.  Individuals elected to fill a vacancy shall serve
 2 only for the remainder of the unexpired term.
 3      (g)  If four vacancies exist at any one time, no remaining
 4 member shall resign until at least one vacancy has been filled in
 5 accordance with this section.
 6      (h)  Five members shall constitute a quorum, whose
 7 affirmative vote shall be necessary for all actions by the board.
 8      (i)  Members shall serve without compensation, but may be
 9 reimbursed for the necessary expenses, including travel expenses,
10 incurred in the performance of their duties.
11         -3 Meetings; notice; open to public.  (a)  The board
12 shall hold regular meetings at least once every two months and
13 shall keep records and minutes for all regular and special
14 meetings pursuant to chapter 92.
15      (b)  Either the chairperson or any five members may convene
16 a special meeting by notifying the entire membership of the board
17 in writing of the time and place of the special meeting.  The
18 chairperson or the five members shall give the written notice at
19 least seven calendar days or at least ten calendar days,
20 respectively, prior to the date of the special meeting.  A
21 special meeting may be convened with the concurrence of the
22 entire membership of the board.
23      (c)  All board meetings shall be open to the public pursuant

Page 6                                                     2160
                                     H.B. NO.           H.D. 2
                                                        S.D. 1

 1 to chapter 92.
 2         -4  Powers and duties.  (a)  The commission shall:
 3      (1)  Adopt rules in accordance with chapter 91 to carry out
 4           the purposes of this chapter, including:
 5           (A)  Eligibility of applicants to receive disbursements
 6                from the trust fund;
 7           (B)  Manner of application for disbursement of moneys
 8                from the trust fund;
 9           (C)  Manner of review of applications;
10           (D)  Criteria for award of disbursements from the trust
11                fund;
12           (E)  Conditions for the use of moneys disbursed such as
13                specification of the types of services that the
14                disbursed moneys may be used to pay for; and
15           (F)  Limits, if any, to the amounts of disbursements to
16                be awarded;
17      (2)  Accept applications for and award disbursements of
18           available money from the trust fund for the purposes of
19           this chapter;
20      (3)  Maintain records of all expenditures of the commission,
21           funds received as gifts and donations, and
22           disbursements made from the trust fund; and
23      (4)  Employ staff, exempt from chapters 76 and 77, that the

Page 7                                                     2160
                                     H.B. NO.           H.D. 2
                                                        S.D. 1

 1           commission deems necessary to carry out the purposes of
 2           this chapter; provided that the commission shall
 3           utilize existing state resources and staff of the
 4           departments of human services, education, and health,
 5           to the greatest extent practicable.
 6      (b)  The commission shall recommend to the governor and the
 7 legislature changes in state programs, statutes, policies,
 8 budgets, and standards relating to the care and rehabilitation of
 9 persons with brain or spinal cord injuries, improve coordination
10 among state agencies that provide care and rehabilitative
11 services, and improve the condition of residents who are in need
12 of rehabilitative services.
13         -5  Traumatic brain injury trust fund.(a)  There is
14 created in the state treasury the traumatic brain injury trust
15 fund as a separate fund in the state treasury.  The director of
16 finance shall have custody of the trust fund and shall credit to
17 the trust fund all amounts transferred to the fund and shall
18 invest the trust fund moneys in the same manner as authorized for
19 investing other moneys in the state treasury.
20      (b)  The commission may authorize the disbursement of
21 available money from the trust fund for purposes of providing
22 care and rehabilitative services to residents of the State who
23 have survived a traumatic brain or spinal cord injury.

Page 8                                                     2160
                                     H.B. NO.           H.D. 2
                                                        S.D. 1

 1      (c)  The trust fund shall be funded by appropriation from
 2 the general revenues of the state.  The commission may also
 3 accept federal funds granted by Congress or executive order for
 4 the purposes of this chapter, as well as gifts and donations from
 5 individuals, private organizations, or foundations.  The
 6 acceptance and use of federal funds shall not commit state funds
 7 and shall not place an obligation upon the legislature to
 8 continue the purposes for which the federal funds are made
 9 available.  All funds received in the manner described in this
10 section shall be transmitted to the director of finance for
11 deposit into the trust fund to be disbursed as other moneys in
12 the trust fund."
13      SECTION 3.  Section 321-28, Hawaii Revised Statutes, is
14 amended to read as follows:
15      "[[]321-28  Traumatic brain injury advisory board.[]]  (a)
16 There is established within the department of health the
17 traumatic brain injury advisory board.  The advisory board shall
18 advise the department [in] and the traumatic brain injury trust
19 fund commission:  
20      (1)  In the development and implementation of a
21           comprehensive plan to address the needs of persons
22           affected by disorders and disabilities that involve the
23           [brain.  Further, the advisory board shall advise the

Page 9                                                     2160
                                     H.B. NO.           H.D. 2
                                                        S.D. 1

 1           department of] brain; and
 2      (2)  Of the feasibility of establishing agreements with
 3           private sector agencies to develop services for persons
 4           with brain injuries.
 5      (b)  The advisory board shall consist of nine members who
 6 shall be appointed by the director of health in accordance with
 7 section 26-35.  The director of health shall designate a member
 8 to be the chairperson of the advisory board.  The director of
 9 health or a designee shall serve as an ex officio nonvoting
10 member of the advisory board.  The members shall serve for a term
11 of four years; provided that upon the initial appointment of the
12 members, two shall be appointed for a term of one year, two for a
13 term of two years, two for a term of three years, and three for a
14 term of four years.  In establishing the advisory board, the
15 director of health shall appoint at least:
16      (1)  Two members representing private sector businesses that
17           provide services for brain injured persons;
18      (2)  Two survivors of traumatic brain injury; and
19      (3)  One member representing trauma centers that provide
20           services for brain injured persons.
21      (c)  The members shall serve without compensation but shall
22 be reimbursed for actual expenses, including travel expenses,
23 that are necessary for the performance of their duties."

Page 10                                                    2160
                                     H.B. NO.           H.D. 2
                                                        S.D. 1

 1      SECTION 4.  There is appropriated out of the general
 2 revenues of the State of Hawaii the sum of $        , or so much
 3 thereof as may be necessary, for fiscal year 2000-2001, to
 4 deposit into the traumatic brain injury trust fund established
 5 under chapter    .
 6      SECTION 5.  Statutory material to be repealed is bracketed.
 7 New statutory material is underscored.
 8      SECTION 6.  This Act shall take effect on July 1, 2000.