RD183 - Commonwealth Neurotrauma Initiative (CNI) Trust Fund Triennial Report For State Fiscal Years 2009, 2010, 2011 (July 1, 2008 through June 30, 2011)


Executive Summary:
Background / Purpose: July 1, 1997, Senate Bill 1132 established the Commonwealth Neurotrauma Initiative (CNI) in the Code of Virginia. This bill authorized the CNI Trust Fund as a special nonreverting fund, as well as the CNI Advisory Board, a permanent collegial body affiliated with the State Board of Health. Effective July 1, 1998, Senate Bill 484 provided that (i) moneys in the CNI Trust Fund “shall be used solely to support grants for Virginia-based organizations, institutions, and researchers” and (ii) “fifty percent [of the moneys in the Fund] shall be allocated for research on the mechanisms and treatment of neurotrauma [referred to as “Option A” below] and fifty percent shall be allocated for rehabilitative services [referred to as “Option B” below].”

The 1998 legislation also created a mechanism for funding the CNI. Moneys are deposited into the Trust Fund pursuant to §18.2-271.1 (E) of the Code of Virginia. That section of the Code provides that a fee of $105 shall be charged “for reinstatement of the driver's license of any person whose privilege or license has been suspended or revoked as a result of . . . [a specified traffic violation],” and $25 of this fee “shall be transferred to the . . . [CNI] Trust Fund.” This mechanism continues to operate, placing additional moneys into the Fund on an ongoing basis.

Leadership: The Commonwealth Neurotrauma Initiative (CNI) Trust Fund is administered by the Department of Rehabilitative Services (DRS). DRS provides management of the Grants Program, as well as staff support to the Advisory Board. The DRS Commissioner serves on the Advisory Board in an ex officio role. The only officer of the Advisory Board is the Chair. In December of the years 2008, 2009, and 2010, David B. Reid, Psy.D., was re-elected for additional one-year terms as Chair of the Advisory Board (per the bylaws of the Advisory Board, the Chair is eligible for re-election). Dr. Reid was originally appointed to the Board in July 2005 to serve a four-year term, filling the Board vacancy for a “person licensed by a health regulatory board within the Department of Health Professions with experience in brain or spinal cord injury rehabilitative programs or services.” He was initially elected as Board Chair in December 2005 for a one-year term. Per bylaws,”…the chairperson shall be elected from the membership of the Advisory Board for a term of one year and shall be eligible for reelection.”

Active Grants: In State Fiscal Year (SFY) 2009, the Fund had twelve (12) active community-based and research grants totaling $1.5 million dollars. In SFY 2010, the Fund had seventeen (17) active grants totaling about $2.0 million (including two grants that were on no-cost extensions). In SFY 2011, the Fund had eleven (11) active grants totaling $1.4 million dollars (including three grants with no-cost extensions).

Grant Funding: At the close of SFY 2009, the Board approved three years of funding totaling $2,810,607 to eight community-based rehabilitative service grantees (Brain Injury Association of Virginia; Brain Injury Resource and Development Center; Brain Injury Services of Southwest Virginia; Crossroads to Brain Injury Recovery; University of Virginia; Virginia Commonwealth University, Rehabilitation, Research and Training Center; Virginia Commonwealth University, The Partnership for People with Disabilities; and the Virginia Assistive Technology System). These eight grantees were awarded funding in response to applications received for a Request for Proposal released in State Fiscal Year’09 (contracts were awarded for SFY 2010, July 1, 2009 through June 30, 2012).

The Board approved three years of funding in the amount of $447,728 to Virginia Commonwealth University’s Department of Physical Medicine and Rehabilitation in SFY 2010 (July 1, 2009 through June 30, 2012) under the DRS Commissioner’s authority designated in State Fiscal Year (SFY) 2004, as follows: budget Item 349#3c allows the Commissioner of the Department of Rehabilitative Services (DRS) to “… reallocate up to $500,000 from unexpended balances in the Commonwealth Neurotrauma Initiative Trust Fund to fund new grant awards for research on traumatic brain and spinal cord injuries.” This grant award allows Virginia Commonwealth University to study screening, evaluation, and intervention programs for youth with brain injury in Virginia’s Department of Juvenile Justice (DJJ) facilities. This grant, in partnership with the Virginia Department of Juvenile Justice (DJJ) and the Brain Injury Association of Virginia (BIAV), will formulate guidelines for brain injury screening, evaluation and intervention. Staff training manuals and related educational materials will be produced, and the grantee will also develop and facilitate DJJ staff training via live training supplemented by written materials. This grant also serves as the cash match portion to the Department of Rehabilitative Services’ Traumatic Brain Injury Federal Grant #6 h21MCCO6763-05-02 awarded from the U.S. Department of Health and Human Services, Health Resources and Services Administration.

One Option-B Community Based Rehabilitative Services grantee, Woodrow Wilson Rehabilitation Center, received a grant to investigate the feasibility of establishing a specialized residential substance abuse treatment program for people with spinal cord injury and/or brain injury. A no-cost extension (i.e., no additional funding of grant dollars) was approved to allow them more time to complete grant activities. This extended their grant through June 30, 2010.

Four months into State Fiscal Year 2010, an Option B - Community Based Rehabilitative Services grantee, the Brain Injury Resource and Development Center realized it could not provide the continuum of services it had hoped using the CNI funds it had been awarded. This was due to unanticipated expenditures that exceeded their grant funding. The grantee requested cancellation of their contract after several months (thereby canceling their contract for the remainder of Year One).

At the close of State Fiscal Year 2010, three Option A - Research and Treatment on the Mechanisms of Neurotrauma grantees at Virginia Commonwealth University were given approval for no-cost extensions ranging from six to twelve months to complete outstanding grant activities. This extended their grants through June 30, 2011 (no additional grant dollars were awarded; however, additional time to complete the grant research using previously awarded grant dollars was given).

At the close of State Fiscal Year 2010, seven of the Option B - Community Based Rehabilitative Services grantees requested carryover from Year One to Year Two of their contracts, totaling $219,215 in carryover dollars. These were funds that were not spent in Year One as originally anticipated due to delayed start up (common with grantees). This increased their Year Two, State Fiscal Year 2011, available balances by $219,215 for a total of $1,046,500 available to those grantees in State Fiscal Year 2011.

Also at the close of State Fiscal Year 2010, one Option B - Community Based Rehabilitative Services grantee originally scheduled to end June 30, 2009 - Woodrow Wilson Rehabilitation Center - needed more time to complete their grant deliverables, which included a trial run to implement a specialized residential substance abuse treatment program on-site for people with spinal cord injury and brain injury. They were approved a second one-year no-cost extension (this does not involve additional grant award dollars, just more time to complete grant activities using previously awarded grant dollars), thereby extending the grant for one more year through June 30, 2011. This grant actually finished and turned in the report early, in January 2011.

Request For Proposals: Early in State Fiscal Year 2010, the CNI Trust Fund Advisory Board issued Request for Proposal (RFP) #10-002 “Development of a Web-Based Case Management Software System” to create a statewide case management software system to be used by the nine (9) state-funded Brain Injury Services (BIS) Programs contracted by DRS. The intention of the RFP was to assist the state-funded Brain Injury Services (BIS) Programs in managing and operating their programs, as well as to improve DRS’ ability to provide general oversight of the contracts. The web-based Brain Injury Case Management Software (BICMS) System would provide a consistent approach to collecting, using, and reporting data. The nine state-funded Brain Injury Services (BIS) Programs would use the system to enhance the daily operation of their 12 programs and to prepare reports for DRS and for their own use. The statewide application would store each organization’s data and would provide a web interface for displaying and entering staff and organizational data. Data for each organization would be accessible only to that organization, and to DRS. The contract was not to exceed a total of $160,000 for development, testing, training, and implementation (nor could it exceed a designated $80,000 per contract year). The Request for Proposals was canceled due to insufficient applications received. DRS Information Systems staff felt that the cap on funding may have been the cause of the inadequate proposals received.

Near the close of State Fiscal Year 2010, the Board issued another Request for Proposals (RFP) #10-327 for the same purpose as described in prior paragraph: the “Development of a Web-Based Case Management Software System.” Six months after extensive review, including thorough analysis by DRS IS staff and approval from the Virginia Information Technology Association (VITA), it was given approval to be released. This time the Board increased the available annual amount slightly, not to exceed a total of $180,000 for development, testing, training, and implementation. The contract also could not exceed $90,000 per contract year. The Fund received thirteen (13) responses to RFP # 10-327. Applications were reviewed by an internal review committee consisting of DRS Information Systems staff. As part of the review process, the Review Committee invited three of the applicants to give in-house demonstrations.

In the Fall of State Fiscal Year 2011, the entire review process was delayed slightly because of Secretary Hazel’s new directive that any information technology (IT) programs had to undergo a thorough review by a specified roundtable of IT state agency executives. CNI Fund staff and DRS IT prepared required documents and the RFP underwent a rigorous review and DRS was given approval to move forward with the RFP process and award. During the RFP and review process, Trust Fund staff noticed monthly revenue was declining significantly. DRS recommended to the CNI Trust Fund Advisory Board that it cancel its Request for Proposals (which resulted in no award being made). Over 18 months of work had been put into the Request for Proposals, the CNI Advisory Board decided to cancel the RFP in the best interest of the Fund.

The CNI Trust Fund Advisory Board also voted to delay the release of another Request for Proposals (RFP) until State Fiscal Year 2013, unless revenue picks up considerably. The Board is taking strategic measures to allow the Fund to continue carrying out its mission while being sound fiscal stewards of Fund dollars.

Financial Status: As noted, six months into SFY 2011, revenue into the Fund had consistently decreased at an alarming rate averaging $87,652 per month versus $95,000 to $110,000 per month, which the Fund had been receiving consistently. DRS staff informed the Advisory Board that, due to the sharp decline in monthly revenue, the cash balance of the Fund had been diminished which affected the ability of the Fund to pay grantees’ expenditures. Due to the decrease in revenue, DRS took action by modifying the reimbursement basis of three contracts from quarterly allotment to a monthly expense reimbursement arrangement (which is how most grants in the Fund operate). This change helped with the cash flow of the Fund and assisted with cash reimbursement to grantees.

As the monthly revenue into the Fund continued to decline during SFY 2011, in an effort to continue to be able to meet grant expenditures, the Board decided at its March 2011 meeting to not approve any further carryover requests from SFY 2011 to SFY 2012. If a grantee requests carryover of funds from SFY 2011 to SFY 2012, the request will be considered; however, if approved, the carryover dollars cannot be expended until State Fiscal Year 2013 (historically that carryover money would have been allowed to be expended during the following fiscal year). This arrangement will require a request for a no-cost extension.

Additionally, as a cost savings measure to counter the decrease in revenue into the Fund in State Fiscal Year 2011 (as well as projections from the Virginia Department of Taxation that revenue for the Fund will likely continue to decline through Fiscal Year 2012), the Advisory Board decided to institute an across the board 11% reduction in SFY 2012 contracts, effective July 1, 2011). This decision was made at the Board’s quarterly business meeting on Friday, March 11, 2011. The grantees were given a month to let the Board staff know how they wanted to modify their current Scope of Services. Most grantee spending trends for Year Two indicated that the reduction would not substantively impact the ability of a grantee to continue its activities and meet its deliverables.

Program Operations: In State Fiscal Year 2009 (July 1, 2008 through June 30, 2009), the Advisory Board of the Commonwealth Neurotrauma Initiative (CNI) Trust Fund held four quarterly business meetings, per bylaws. In addition, the Board held Community Colloquium in which current Option B - Community-based Rehabilitative Grants presented to the Advisory Board and fellow grantees on their grant activities as well as results and progress to date. In SFY 2010 (July 1, 2009 through June 30, 2010), the Board held four quarterly business meetings, per bylaws, as well as an Research Colloquium in which current Option A - Research on the Mechanisms and Treatment of Neurotrauma grantees presented to the Advisory Board and fellow grantees on their research activities as well as results and progress to date. In SFY 2011 (July 1, 2010 through June 30, 2011), the Advisory Board held its four mandatory quarterly business meetings, per bylaws.

Advisory Board: There were no new Advisory Board members appointed to the Commonwealth Neurotrauma Initiative Trust Fund Advisory Board in State Fiscal Years 2009, 2010, or 2011 (as no terms expired during that time period). The next Board appointments will take place in SFY 2013, effective July 1, 2012, for two upcoming vacancies.

Administrative Staff: In Fiscal Years 2009, 2010 and the first half of 2011, administrative staff for the Fund consisted of one full-time position (CNI Trust Fund Program Specialist who administers the Fund and provides staff support to the Advisory Board); and two part-time (15% and 10%) positions (Manager of the DRS Brain Injury Services Coordination Unit, and Administrative and Fiscal Specialist). The Manager of the DRS Brain Injury Services Coordination Unit provides supervisory oversight for the operation and management of the CNI Trust Fund program, and the Administrative and Fiscal specialist provides administrative support to the Fund as needed. Due to a substantial decrease in revenue into the Fund, funding for these two part-time positions (15% and 10% positions) was shifted to a funding source to reduce overall expenditures.

Program Funds: Moneys have been collected and deposited into the CNI Trust Fund since 1998, when a citizen donated $25 to the Fund. The funding mechanism for CNI (a reinstatement fee charged to restore an operator's license that has been revoked or suspended for specified dangerous driving offenses) was established by legislation in 1998, a year after the Trust Fund and the Advisory Board were established in the Code of Virginia. The CNI Trust Fund is a special nonreverting fund in the state treasury. The Fund balance has continually increased by a statutory funding mechanism in which a portion of the reinstatement fee is deposited into the Fund ($25 out of a $30 fee that is collected for reinstatement).

The Fund consists of grants, donations, and bequests from public or private sources and funds collected as provided in § 46.2-411 of the Code. The revenue in State Fiscal Year 2009 averaged about $98,867 per month, or approximately $1.18 million for the year; in State Fiscal Year 2010 it averaged about $96,181 per month, or approximately $1.15 million / year; and in State Fiscal Year 2011 it averaged about $88,221 per month, or approximately $1.05 million / year. Historically the revenue coming into the Fund has been relatively stable since it was established; however, the Fund began to see a slow, but steady monthly decline in revenue in State Fiscal Year 2011.

In State Fiscal Year 2009, staff and other administrative costs were budgeted at $75,961 with $76,820 in actual expenditures. For State Fiscal Year 2010, staff and other administrative costs were budgeted at $78,085 with $77,222 in actual expenditures. For State Fiscal Year 2011, staff and administrative costs were budgeted at $83,120 with $68,464 actually expended.

Due to decreased revenue into the Fund in SFY 2011, and projections from the Virginia Department of Taxation, revenue for the Fund will likely continue to decline through Fiscal Year 2012. Therefore, the Advisory Board decided to institute an across the board 11% reduction in all SFY 2012 contracts, July 1, 2011 (beginning of SFY ’12). This decision was made at the Board’s quarterly business meeting on Friday, March 11, 2011. Grantees were given a month to let the Board staff know how (and if) they wanted to modify their current Scope of Services. Most grantees indicated that the 11% reduction would not severely affect their ability to carry out grant activities and meet their contract deliverables.