Rule-Making Standards and Procedures s12

STATEMENT OF BASIS AND PURPOSE

Summary of the basis and purpose for the rule or rule change. (State what the rule says or does, explain why the rule or rule change is necessary and what the program hopes to accomplish through this rule.)

The proposed rule changes are in response to Executive Order D 2011-005 to reduce rules that are redundant in statute, contracts or policy. All the proposed revisions reflect the request of this order. The TBI Program proposes revisions to current program rules. No rules are being repealed. The purposes of the revisions are to provide clarity of the rules and consistency of language with the program. Additionally, although rules are not mandated, they provide a resource for the public to learn about the program. Finally the purpose is to remove items from rules that are already stated in our statute or that can be addressed through policy or contracts.

An emergency rule-making (which waives the initial Administrative Procedure Act noticing requirements) is necessary:

Explain:

Authority for Rule:

State Board Authority: 26-1-107, C.R.S. (2011) - State Board to promulgate rules; 26-1-109, C.R.S. (2011) - State Board rules to coordinate with federal programs; 26-1-111, C.R.S. (2011) - State Board to promulgate rules for public assistance and welfare activities.

Program Authority: (give federal and/or state citations and a summary of the language authorizing the rule-making)

There is no statutory requirement to promulgate rules for this program. Rules have been promulgated to ensure the public is aware of the program and the governance of the program. The following citations authorize rule making; 24-4-105, C.R.S. (2011) – Hearing and Determinations and 26-1-302, C.R.S. – TBI statute

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[Note: “Strikethrough” indicates deletion from existing rules and “all caps” indicates addition of new rules.]

STATEMENT OF BASIS AND PURPOSE (continued)

Does the rule incorporate material by reference?

Does this rule repeat language found in statute?

If yes, please explain.

1) In section 12.520, there is reference to “protective health information” Public Law Number 104-191.

2) The definition of Traumatic Brain Injury is repeated in rule from statute. In addition, it is stated in rule that all program participants will receive care coordination this is also mandated in statute.

State Board Administration will send this rule-making package to Colorado Counties, Inc., Office of State Planning and Budgeting, and the Joint Budget Committee. The program has sent this proposed rule-making package to which stakeholders?

Colorado Traumatic Brain Injury Trust Fund Board of Directors

Colorado Connections of Denver Options Inc., TBI Trust Fund and Veteran’s Program Operation TBI Freedom

Colorado Advisory Council on Brain Injury

Traumatic Brain Injury Networking Teams Steering Committee

Brain Injury Collaborative

Colorado Department of Education

Colorado Department of Public Health and Environment/Health Care Program for Children with Special Needs

Department of Health Care Policy and Financing

Colorado Department of Human Services/Division of Vocational Rehabilitation

Colorado Department of Human Services/Division of Behavioral Health

Attachments:

Regulatory Analysis

Overview of Proposed Rule

Stakeholder Comment Summary

Rule-making Form SBA-3a (08/09)

REGULATORY ANALYSIS

(complete each question; answers may take more than the space provided)

1. List of groups impacted by this rule:

Which groups of persons will benefit, bear the burdens or be adversely impacted by this rule?

Individuals with brain injury and their families will benefit from these rules. The rules provide transparency as to the program, specifically the appeals and grievances procedures.

The program will positively benefit from the proposed rule revisions. There are aspects of the current rules that are more appropriately addressed through contracts or policy and procedures.

There are no adverse impacts of this rule.

2. Describe the qualitative and quantitative impact:

How will this rule-making impact those groups listed above? How many people will be impacted? What are the short-term and long-term consequences of this rule?

The program serves approximately 800-900 individuals per year. This number expands greatly when you consider the families of these individuals.

The short and long term consequences of these rules are to provide clarity to the public. Additionally, previously, there were parts of the rules that unnecessarily restricted the flexibility of the program. The proposed revisions remove these sections of rules. These are better addressed through contracts or policy and procedures.

3. Fiscal Impact:

For each of the categories listed below explain the distribution of dollars; please identify the costs, revenues, matches or any changes in the distribution of funds even if such change has a total zero effect for any entity that falls within the category. If this rule-making requires one of the categories listed below to devote resources without receiving additional funding, please explain why the rule-making is required and what consultation has occurred with those who will need to devote resources.

State Fiscal Impact (Identify all state agencies with a fiscal impact, including any Colorado Benefits Management System (CBMS) change request costs required to implement this rule change)

There is no state fiscal impact to these rule revisions.

County Fiscal Impact

There is no county fiscal impact to these rule revisions.

Federal Fiscal Impact

There is no Federal fiscal impact to these rule revisions.

Rule-making Form SBA-3b (10/08)

REGULATORY ANALYSIS (continued)

Other Fiscal Impact (such as providers, local governments, etc.)

There is no fiscal impact to these rule revisions.

4. Data Description:

List and explain any data, such as studies, federal announcements, or questionnaires, which were relied upon when developing this rule?

5. Alternatives to this Rule-making:

Describe any alternatives that were seriously considered. Are there any less costly or less intrusive ways to accomplish the purpose(s) of this rule? Explain why the program chose this rule-making rather than taking no action or using another alternative.

No alternatives were considered. The Program chose rule-making as a means to provide the public information about the Traumatic Brain Injury Program and process for accessing the program. Additionally, this provides clients information on the grievance and appeals process.

Rule-making Form SBA-3b (10/08)

OVERVIEW OF PROPOSED RULE

Compare and/or contrast the content of the current regulation and the proposed change.

Stakeholder Comment

Stakeholder Comment

Rule-making Form SBA-3c (10/08)

STAKEHOLDER COMMENT SUMMARY

DEVELOPMENT

The following individuals and/or entities were included in the development of these proposed rules (such as other Program Areas, Legislative Liaison, and Sub-PAC.

TBI Trust Fund Board of Directors

Contractors for the Program

Sub-PAC

THIS RULE-MAKING PACKAGE

The following individuals and/or entities were contacted and informed that this rule-making was proposed for consideration by the State Board of Human Services:

Colorado Traumatic Brain Injury Trust Fund Board of Directors

Colorado Connections of Denver Options Inc. TBI Trust Fund and Veteran’s Program Operation TBI Freedom

Colorado Advisory Council on Brain Injury

Traumatic Brain Injury Networking Teams Steering Committee

Brain Injury Collaborative

Colorado Department of Education

Colorado Department of Public Health and Environment/Health Care Program for Children with Special Needs

Department of Health Care Policy and Financing

Colorado Department of Human Services/Division of Vocational Rehabilitation

Colorado Department of Human Services/Division of Behavioral Health

Are other State Agencies (such as Colorado Department of Health Care Policy and Financing) impacted by these rules? If so, have they been contacted and provided input on the proposed rules?

The rules were emailed to each of the following entities. Additionally, they were discussed at a face to face meeting with the individuals identified in both the HCPF and CDE.

The TBI Program rules were given to Tyler Deines, Brain Injury Medicaid Waiver Coordinator at the Colorado Department of Policy and Financing to review.

Additionally the rules were given to Kathy Patrick, Karen McAvoy and Kristy Werther of the Colorado Department of Education for review.

Finally, the rules were sent to Carla Rowland and Shirley Babler at the Colorado Department of Public Health and Environment (CDPHE), Health Care Program for Children with Special Needs to review and also to Barbara Gabella at CDPHE.

STAKEHOLDER COMMENT SUMMARY (continued)

Have these rules been reviewed by the appropriate Sub-PAC Committee?

Date presented _January 5, 2012____. Were there any issues raised? ____ Yes __X_ No

If not, why.

Comments were received from stakeholders on the proposed rules:

If “yes” to any of the above questions, summarize and/or attach the feedback received by specifying the section and including the Department/Office/Division response. Provide proof of agreement or ongoing issues with a letter or public testimony by the stakeholder.

Rules are currently being reviewed by the identified list of stakeholders. Rules were discussed at the TBI Trust Fund Board of Directors. The board unanimously agreed that the revisions were appropriate. The rules are currently being reviewed by Colorado Connections of Denver Options, the agency that we contract with to provide care coordination.

Formal feedback was requested by 12/30/11. Verbal feedback has been positive with no suggested changes to the proposed revisions. The rules were reviewed by the Traumatic Brain Injury Networking Team Steering Committee.

The only suggested change was to broaden the definition of individuals we serve to include the broader term of Acquired Brain Injury. This definition change would require a statute change. Additionally, it would have a fiscal impact as it would significantly increase the population of individuals we would serve.

Rule-making Form SBA-3d (08/11)

12 CCR 2512-2

COLORADO TRAUMATIC BRAIN INJURY PROGRAM 12.500 – 12.520

12.500 COLORADO TRAUMATIC BRAIN INJURY PROGRAM

12.510 INTRODUCTION

These rules implement the Colorado Traumatic Brain Injury Program (Program) as defined in Title 26, Article 1, Part 3, C.R.S.

Individuals who are eligible for program services do not have an entitlement to services. Program services are subject to available funding. If the demand for and need for services exceeds the available funding, the entity under contract to provide services shall maintain a wait list of eligible persons. Individuals shall receive program services on a first-come, first-served basis. The TBI Program Director, TBI Board of Directors and Contractor shall determine how to best manage the wait list.

12.520 DEFINITIONS

“Applicant” means an individual for whom an application or referral for services has been completed.

“Care Coordination” means a collaborative process that assesses, plans, implements, coordinates, monitors and evaluates the options and services required to meet individual's needs, using communication and available resources to promote quality, cost effective outcomes. Traumatic brain injury care coordination operates with an underlying premise that when individuals reach their optimal level of wellness and functional capability, everyone benefits: the individual and family being served, their community support systems, the healthcare delivery system, and insurance carriers. The primary functions of TBI care coordination are to: