[DOCID: f:hr567.110]
From the House Reports Online via GPO Access
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110th Congress Report
HOUSE OF REPRESENTATIVES
2d Session 110-567
======================================================================
TRAUMATIC BRAIN INJURY ACT OF 2008
_______
April 8, 2008.--Committed to the Committee of the Whole House on the
State of the Union and ordered to be printed
_______
Mr. Dingell, from the Committee on Energy and Commerce, submitted the
following
R E P O R T
[To accompany H.R. 1418]
[Including cost estimate of the Congressional Budget Office]
The Committee on Energy and Commerce, to whom was referred
the bill (H.R. 1418) to provide for the expansion and
improvement of traumatic brain injury programs, having
considered the same, report favorably thereon with an amendment
and recommend that the bill as amended do pass.
CONTENTS
Page
Amendment........................................................ 1
Purpose and Summary.............................................. 4
Background and Need for Legislation.............................. 4
Hearings......................................................... 5
Committee Consideration.......................................... 5
Committee Votes.................................................. 5
Committee Oversight Findings..................................... 5
Statement of General Performance Goals and Objectives............ 5
New Budget Authority, Entitlement Authority, and Tax Expenditures 5
Earmarks and Tax and Tariff Benefits............................. 6
Committee Cost Estimate.......................................... 6
Congressional Budget Office Estimate............................. 6
Federal Mandates Statement....................................... 8
Advisory Committee Statement..................................... 8
Constitutional Authority Statement............................... 8
Applicability to Legislative Branch.............................. 8
Section-by-Section Analysis of the Legislation................... 8
Changes in Existing Law Made by the Bill, as Reported............ 10
Amendment
The amendment is as follows:
Strike all after the enacting clause and insert the
following:
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Traumatic Brain Injury Act of 2008''.
SEC. 2. CONFORMING AMENDMENTS RELATING TO RESTRUCTURING.
Part J of title III of the Public Health Service Act (42 U.S.C. 280b
et seq.) is amended--
(1) by redesignating the section 393B (42 U.S.C. 280b-1c)
relating to the use of allotments for rape prevention
education, as section 393A and moving such section so that it
follows section 393;
(2) by redesignating existing section 393A (42 U.S.C. 280b-
1b) relating to prevention of traumatic brain injury, as
section 393B; and
(3) by redesignating the section 393B (42 U.S.C. 280b-1d)
relating to traumatic brain injury registries, as section 393C.
SEC. 3. TRAUMATIC BRAIN INJURY PROGRAMS OF THE CENTERS FOR DISEASE
CONTROL AND PREVENTION.
(a) Prevention of Traumatic Brain Injury.--Clause (ii) of section
393B(b)(3)(A) of the Public Health Service Act, as so redesignated, (42
U.S.C. 280b-1b) is amended by striking ``from hospitals and trauma
centers'' and inserting ``from hospitals and emergency departments''.
(b) National Program for Traumatic Brain Injury Surveillance and
Registries.--Section 393C of the Public Health Service Act, as so
redesignated, (42 U.S.C. 280b et seq.) is amended--
(1) in the section heading, by inserting ``surveillance and''
after ``national program for traumatic brain injury''; and
(2) in subsection (a), in the matter preceding paragraph (1),
by striking ``may make grants'' and all that follows through
``to collect data concerning--'' and inserting ``may make
grants to States or their designees to develop or operate the
State's traumatic brain injury surveillance system or registry
to determine the incidence and prevalence of traumatic brain
injury and related disability, to ensure the uniformity of
reporting under such system or registry, to link individuals
with traumatic brain injury to services and supports, and to
link such individuals with academic institutions to conduct
applied research that will support the development of such
surveillance systems and registries as may be necessary. A
surveillance system or registry under this section shall
provide for the collection of data concerning--''.
(c) Report.--Section 393C of the Public Health Service Act (as so
redesignated) is amended by adding at the end the following:
``(b) Not later than 18 months after the date of enactment of the
Traumatic Brain Injury Act of 2008, the Secretary, acting through the
Director of the Centers for Disease Control and Prevention and the
Director of the National Institutes of Health and in consultation with
the Secretary of Defense and the Secretary of Veterans Affairs, shall
submit to the relevant committees of Congress a report that contains
the findings derived from an evaluation concerning activities and
procedures that can be implemented by the Centers for Disease Control
and Prevention to improve the collection and dissemination of
compatible epidemiological studies on the incidence and prevalence of
traumatic brain injury in those with traumatic brain injury who were
formerly in the military. The report shall include recommendations on
the manner in which such agencies can further collaborate on the
development and improvement of traumatic brain injury diagnostic tools
and treatments.''.
SEC. 4. STUDY ON TRAUMATIC BRAIN INJURY.
Part J of title III of the Public Health Service Act (42 U.S.C. 280b
et seq.) is amended by inserting after section 393C, as so
redesignated, the following:
``SEC. 393C-1. STUDY ON TRAUMATIC BRAIN INJURY.
``(a) Study.--The Secretary, acting through the Director of the
Centers for Disease Control and Prevention with respect to paragraph
(1) and in consultation with the Director of the National Institutes of
Health and other appropriate entities with respect to paragraphs (2),
(3), and (4), may conduct a study with respect to traumatic brain
injury for the purpose of carrying out the following:
``(1) In collaboration with appropriate State and local
health-related agencies--
``(A) determining the incidence of traumatic brain
injury and prevalence of traumatic brain injury related
disability and the clinical aspects of the disability
in all age groups and racial and ethnic minority groups
in the general population of the United States,
including institutional settings, such as nursing
homes, correctional facilities, psychiatric hospitals,
child care facilities, and residential institutes for
people with developmental disabilities; and
``(B) reporting national trends in traumatic brain
injury.
``(2) Identifying common therapeutic interventions which are
used for the rehabilitation of individuals with such injuries,
and, subject to the availability of information, including an
analysis of--
``(A) the effectiveness of each such intervention in
improving the functioning, including return to work or
school and community participation, of individuals with
brain injuries;
``(B) the comparative effectiveness of interventions
employed in the course of rehabilitation of individuals
with brain injuries to achieve the same or similar
clinical outcome; and
``(C) the adequacy of existing measures of outcomes
and knowledge of factors influencing differential
outcomes.
``(3) Identifying interventions and therapies that can
prevent or remediate the development of secondary neurologic
conditions related to traumatic brain injury.
``(4) Developing practice guidelines for the rehabilitation
of traumatic brain injury at such time as appropriate
scientific research becomes available.
``(b) Dates Certain for Reports.--If the study is conducted under
subsection (a), the Secretary shall, not later than 3 years after the
date of the enactment of the Traumatic Brain Injury Act of 2008, submit
to Congress a report describing findings made as a result of carrying
out such subsection (a).
``(c) Definition.--For purposes of this section, the term `traumatic
brain injury' means an acquired injury to the brain. Such term does not
include brain dysfunction caused by congenital or degenerative
disorders, nor birth trauma, but may include brain injuries caused by
anoxia due to trauma including near drowning. The Secretary may revise
the definition of such term as the Secretary determines necessary.''.
SEC. 5. TRAUMATIC BRAIN INJURY PROGRAMS OF THE NATIONAL INSTITUTES OF
HEALTH.
Section 1261 of the Public Health Service Act (42 U.S.C. 300d-61) is
amended--
(1) in subsection (b)(2), by striking ``Labor and Human
Resources'' and inserting ``Health, Education, Labor, and
Pensions'';
(2) in subparagraph (D) of subsection (d)(4), by striking
``head brain injury'' and inserting ``brain injury''; and
(3) in subsection (i), by inserting ``, and such sums as may
be necessary for each of the fiscal years 2009 through 2012''
before the period at the end.
SEC. 6. TRAUMATIC BRAIN INJURY PROGRAMS OF THE HEALTH RESOURCES AND
SERVICES ADMINISTRATION.
(a) State Grants for Demonstration Projects Regarding Traumatic Brain
Injury.--Section 1252 of the Public Health Service Act (42 U.S.C. 300d-
52) is amended--
(1) in subsection (a)--
(A) by striking ``may make grants to States'' and
inserting ``may make grants to States and American
Indian consortia''; and
(B) by striking ``health and other services'' and
inserting ``rehabilitation and other services'';
(2) in subsection (b)--
(A) in paragraphs (1), (3)(A)(i), (3)(A)(iii), and
(3)(A)(iv), by striking the term ``State'' each place
such term appears and inserting the term ``State or
American Indian consortium''; and
(B) in paragraph (2), by striking ``recommendations
to the State'' and inserting ``recommendations to the
State or American Indian consortium'';
(3) in subsection (c)(1), by striking the term ``State'' each
place such term appears and inserting ``State or American
Indian consortium'';
(4) in subsection (e), by striking ``A State that received''
and all that follows through the period and inserting ``A State
or American Indian consortium that received a grant under this
section prior to the date of the enactment of the Traumatic
Brain Injury Act of 2008 may complete the activities funded by
the grant.'';
(5) in subsection (f)--
(A) in the subsection heading, by inserting ``and
American Indian Consortium'' after ``State'';
(B) in paragraph (1) in the matter preceding
subparagraph (A), paragraph (1)(E), paragraph (2)(A),
paragraph (2)(B), paragraph (3) in the matter preceding
subparagraph (A), paragraph (3)(E), and paragraph
(3)(F), by striking the term ``State'' each place such
term appears and inserting ``State or American Indian
consortium''; and
(C) in clause (ii) of paragraph (1)(A), by striking
``children and other individuals'' and inserting
``children, youth, and adults'';
(6) in subsection (h)--
(A) by striking ``Not later than 2 years after the
date of the enactment of this section, the Secretary''
and inserting ``Not less than biennially, the
Secretary'';
(B) by striking ``Commerce of the House of
Representatives, and to the Committee on Labor and
Human Resources'' and inserting ``Energy and Commerce
of the House of Representatives, and to the Committee
on Health, Education, Labor, and Pensions''; and
(C) by inserting ``and section 1253'' after
``programs established under this section,'';
(7) by amending subsection (i) to read as follows:
``(i) Definitions.--For purposes of this section:
``(1) The terms `American Indian consortium' and `State' have
the meanings given to those terms in section 1253.
``(2) The term `traumatic brain injury' means an acquired
injury to the brain. Such term does not include brain
dysfunction caused by congenital or degenerative disorders, nor
birth trauma, but may include brain injuries caused by anoxia
due to trauma. The Secretary may revise the definition of such
term as the Secretary determines necessary, after consultation
with States and other appropriate public or nonprofit private
entities.''; and
(8) in subsection (j), by inserting ``, and such sums as may
be necessary for each of the fiscal years 2009 through 2012''
before the period.
(b) State Grants for Protection and Advocacy Services.--Section 1253
of the Public Health Service Act (42 U.S.C. 300d-53) is amended--
(1) in subsections (d) and (e), by striking the term
``subsection (i)'' each place such term appears and inserting
``subsection (l)'';
(2) in subsection (g), by inserting ``each fiscal year not
later than October 1,'' before ``the Administrator shall pay'';
(3) by redesignating subsections (i) and (j) as subsections
(l) and (m), respectively;
(4) by inserting after subsection (h) the following:
``(i) Data Collection.--The Administrator of the Health Resources and
Services Administration and the Commissioner of the Administration on
Developmental Disabilities shall enter into an agreement to coordinate
the collection of data by the Administrator and the Commissioner
regarding protection and advocacy services.
``(j) Training and Technical Assistance.--
``(1) Grants.--For any fiscal year for which the amount
appropriated to carry out this section is $6,000,000 or
greater, the Administrator shall use 2 percent of such amount
to make a grant to an eligible national association for
providing for training and technical assistance to protection
and advocacy systems.
``(2) Definition.--In this subsection, the term `eligible
national association' means a national association with
demonstrated experience in providing training and technical
assistance to protection and advocacy systems.
``(k) System Authority.--In providing services under this section, a
protection and advocacy system shall have the same authorities,
including access to records, as such system would have for purposes of
providing services under subtitle C of the Developmental Disabilities
Assistance and Bill of Rights Act of 2000.''; and
(5) in subsection (l) (as redesignated by this subsection) by
striking ``2002 through 2005'' and inserting ``2009 through
2012''.
Purpose and Summary
The purpose of H.R. 1418, the ``Traumatic Brain Injury Act
of 2008'', is to authorize research and public health
activities related to trauma and traumatic brain injury.
Background and Need for Legislation
Traumatic brain injuries (TBIs) are caused by sudden jolts,
blows, or penetrating head traumas that disrupt brain function.
Although a traumatic brain injury can happen to anyone, young
children, teenaged boys, elderly persons, and military
personnel are especially at risk.
According to the Centers for Disease Control and Prevention
(CDC), of the 1.5 million Americans who sustain a TBI each
year, around 50,000 die and another 80,000 to 90,000 experience
long-term or lifelong disabilities as a result. Traumatic brain
injuries can result in disability and the need for help to
perform daily living activities.
TBI is different from other disabilities due to the
severity of cognitive loss. Most rehabilitation programs are
designed for people with physical disabilities, not cognitive
disabilities that require special accommodations. Finding
needed services is typically a logistical, financial, and
psychological challenge for family members and other
caregivers, because few coordinated systems of care exist for
individuals with TBI.
The passage of the Traumatic Brain Injury Act of 1996 has
improved TBI service systems at the State level and has
increased the overall visibility of TBI. More work, however,
needs to be done at both the national and State levels to build
an effective, durable service system that meets the needs of
individuals with TBI.
Hearings
There were no hearings held in connection to the bill
reported by the Committee.
Committee Consideration
Tuesday, March 11, 2008, the Subcommittee on Health met in
open markup session and favorably forwarded H.R. 1418, amended,
to the full Committee for consideration, by a voice vote. On
Thursday, March 13, 2008, the full Committee met in open markup
session and ordered H.R. 1418 favorably reported to the House,
as amended by the Subcommittee on Health, by a voice vote. No
amendments were offered during full Committee consideration.
Committee Votes
Clause 3(b) of rule XIII of the Rules of the House of
Representatives requires the Committee to list the record votes
on the motion to report legislation and amendments thereto.
There were no record votes taken on amendments or in connection
with ordering H.R. 1418 reported to the House. A motion by Mr.
Dingell to order H.R. 1418 favorably reported to the House, as
amended, was agreed to by a voice vote.
Committee Oversight Findings
Regarding clause 3(c)(1) of rule XIII of the Rules of the
House of Representatives, the oversight findings of the
Committee regarding H.R. 1418 are reflected in this report.
Statement of General Performance Goals and Objectives
The objective of H.R. 1418 is to expand and improve TBI
programs to reduce the incidence of TBI through basic and
applied research, public education, injury surveillance, and
demonstration projects to improve protection and advocacy
systems.
New Budget Authority, Entitlement Authority, and Tax Expenditures
Regarding compliance with clause 3(c)(2) of rule XIII of
the Rules of the House of Representatives, the Committee finds
that H.R. 1418 would result in no new or increased budget
authority, entitlement authority, or tax expenditures or
revenues.
Earmarks and Tax and Tariff Benefits
Regarding compliance with clause 9 of rule XXI of the Rules
of the House of Representatives, H.R. 1418 does not contain any
congressional earmarks, limited tax benefits, or limited tariff
benefits as defined in clause 9(d), 9(e), or 9(f) of rule XXI.
Committee Cost Estimate
The Committee adopts as its own the cost estimate on H.R.
1418 prepared by the Director of the Congressional Budget
Office pursuant to section 402 of the Congressional Budget Act
of 1974.
Congressional Budget Office Estimate
Pursuant to clause 3(c)(3) of rule XIII of the Rules of the
House of Representatives, the following is the cost estimate on
H.R. 1418 provided by the Congressional Budget Office pursuant
to section 402 of the Congressional Budget Act of 1974:
U.S. Congress,
Congressional Budget Office,
Washington, DC, April 7, 2008.
Hon. John D. Dingell,
Chairman, Committee on Energy and Commerce,
House of Representatives, Washington, DC.
Dear Mr. Chairman: The Congressional Budget Office has
prepared the enclosed cost estimate for H.R. 1418, the
Traumatic Brain Injury Act of 2008.
If you wish further details on this estimate, we will be
pleased to provide them. The CBO staff contacts are Sarah
Evans, Tim Gronniger, and Lara Robillard.
Sincerely,
Robert A. Sunshine
(For Peter R. Orszag, Director).
H.R. 1418--Traumatic Brain Injury Act of 2008
Summary: H.R. 1418 would amend the Public Health Services
Act to authorize research and public health activities related
to trauma and traumatic brain injury (TBI). CBO estimates that
implementing the bill would cost $117 million in 2009 and $1.6
billion over the 2009-2013 period, subject to the appropriation
of the necessary amounts. Enacting H.R. 1418 would not affect
direct spending or federal revenues.
H.R. 1418 contains no intergovernmental or private-sector
mandates as defined in the Unfunded Mandates Reform Act (UMRA);
any costs to state governments and Indian consortia would
result from complying with conditions of federal assistance.
Estimated cost to the Federal Government: The estimated
budgetary impact of H.R. 1418 is shown in the following table.
The costs of this legislation fall within budget function 550
(health).
----------------------------------------------------------------------------------------------------------------
By fiscal year, in millions of dollars--
-----------------------------------------------
2008 2009 2010 2011 2012 2013
----------------------------------------------------------------------------------------------------------------
SPENDING SUBJECT TO APPROPRIATION
Spending Under Current Law:
Budget Authority\1\......................................... 391 0 0 0 0 0
Estimated Outlays........................................... 402 279 60 9 0 0
Proposed Changes:
Estimated Authorization Level\1\............................ 0 398 405 413 423 6
Estimated Outlays........................................... 0 117 338 398 411 295
Spending Under H.R. 1418:
Estimated Authorization Level\1\............................ 391 398 405 413 423 6
Estimated Outlays........................................... 402 396 399 407 411 295
----------------------------------------------------------------------------------------------------------------
\1\The 2008 level is the amount appropriated for that year for research and other federal activities related to
traumatic brain injury.
Basis of estimate: H.R. 1418 would authorize funding for
research, treatment, surveillance, and education activities
related to trauma and traumatic brain injury at the National
Institutes of Health (NIH), the Health Resources and Services
Administration (HRSA), and the Centers for Disease Control and
Prevention (CDC). CBO estimates that those activities would
require the appropriation of $398 million in 2009 and $1.6
billion over the 2009-2013 period. Assuming the appropriation
of necessary amounts, CBO estimates that implementing H.R. 1418
would cost $117 million in 2009 and $1.6 billion over the 2009-
2013 period.
The NIH estimates that it will allocate $376 million for
trauma-related activities in fiscal year 2008. H.R. 1418 would
authorize the appropriation of such sums as are necessary for
those activities over the 2009-2012 period. Based on historical
program expenditures at NIH and adjusting for inflation, CBO
estimates that NIH would require the appropriation of $383
million for 2009 and $1.6 billion over the 2009-2013 period to
conduct the specified activities. Implementing those programs
would cost $111 million in 2009 and $1.5 billion over the 2009-
2013 period, assuming appropriation of the necessary amounts.
HRSA allocated $9 million in 2008 for grants to states to
expand access to care and protection services for TBI. H.R.
1418 would authorize the appropriation of such sums as are
necessary for those activities over the 2009-2012 period, and
would expand the program to allow consortia of American Indians
to receive such grants. Based on historical spending of those
programs, CBO estimates that the agency would require the
appropriation of $9 million in 2009 and $37 million over the
2009-2012 period to carry out activities specified by the bill.
CBO estimates that implementing those provisions of H.R. 1418
would cost $3 million in 2009 and $24 million over the 2009-
2013 period, assuming that the necessary amounts are
appropriated and that future rates of spending resemble
historical patterns for similar activities.
In 2008, the Centers for Disease Control and Prevention
allocated $6 million for TBI-related activities, including
grants to states' TBI surveillance programs and educational
activities. H.R. 1418 would authorize the appropriation of
necessary amounts for those and other TBI-related activities,
which CBO estimates would require $6 million in 2009 and $30
million over the 2009-2013 period. Based on historical spending
patterns for those activities, and assuming appropriation of
the necessary amounts, CBO estimates that implementing H.R.
1418's CDC provisions would cost $3 million in 2009 and $26
million over the 2009-2013 period.
Intergovernmental and private-sector impact: H.R. 1418
contains no intergovernmental or private-sector mandates as
defined in UMRA. State governments and Indian consortia would
benefit from grant funding authorized by the bill. Any costs
incurred by those entities to qualify for such grants would be
incurred voluntarily as conditions of federal assistance.
Previous CBO estimates: On July 23, 2007, CBO transmitted a
cost estimate for S. 793, the Traumatic Brain Injury
Reauthorization Act of 2007, as ordered reported by the Senate
Committee on Health, Education, Labor, and Pensions on June 27,
2007. The two bills are very similar, except that S. 793 would
authorize appropriations for the activities administered by
HRSA and NIH for the 2008-2011 period (rather than the 2009-
2012 period specified in H.R. 1418). CBO's estimate for H.R.
1418 differs from that for S. 793 because the authorized
periods differ, and because the estimate for H.R. 1418 takes
into account funding appropriated for fiscal year 2008 for TBI-
related activities.
Estimate prepared by: Federal Costs: Sarah Evans, Tim
Gronniger, and Lara Robillard. Impact on State, Local, and
Tribal Governments: Lisa Ramirez-Branum. Impact on the Private
Sector: Patrick Bernhardt.
Estimate approved by: Keith J. Fontenot, Deputy Assistant
Director for Health and Human Resources, Budget Analysis
Division.
Federal Mandates Statement
The Committee adopts as its own the estimate of Federal
mandates regarding H.R. 1418 prepared by the Director of the
Congressional Budget Office pursuant to section 423 of the
Unfunded Mandates Reform Act.
Advisory Committee Statement
No advisory committees within the meaning of section 5(b)
of the Federal Advisory Committee Act would be created by H.R.
1418.
Constitutional Authority Statement
Pursuant to clause 3(d)(1) of rule XIII of the Rules of the
House of Representatives, the Committee finds that the
Constitutional authority for H.R. 1418 is provided in the
provisions of Article I, section 8, clause 1, that relate to
expending funds to provide for the general welfare of the
United States.
Applicability to Legislative Branch
The Committee finds that H.R. 1418 does not relate to the
terms and conditions of employment or access to public services
or accommodations within the meaning of section 102(b)(3) of
the Congressional Accountability Act of 1995.
Section-by-Section Analysis of the Legislation
Section 1. Short title
Section 1 specifies the short title of the legislation as
the ``Reauthorization of the Traumatic Brain Injury Act''.
Section 2. Conforming amendments relating to restructuring
Section 2 re-designates section 393B as section 393A,
section 393A as section 393B, and section 393B as section 393C,
so that sections pertaining to TBI follow and are not
interrupted by the other provisions of the Public Health
Service Act (PHSA).
Section 3. Traumatic brain injury programs of the Centers for Disease
Control and Prevention
Section 3 amends part J of Title III of the PHSA as re-
designated (42 U.S.C. 280b-1b) authorize the dissemination of
information related to TBI and its secondary conditions upon an
individual's discharge from hospitals and emergency centers.
Section 393C of the PHSA, as re-designated (42 U.S.C. 280B
et seq.), is amended to change the section heading to the
`National Program for Brain Injury Surveillance and
Registries.' This section authorizes grants to States or their
designees to develop or operate the State's TBI-surveillance
system or registry to determine the incidence and prevalence of
TBI. The Secretary of the Department of Health and Human
Services (Secretary) is authorized to ensure the uniformity of
reporting information. It also ensures that individuals with a
TBI are linked with academic institutions to conduct applied
research that will support the development of such surveillance
systems and registries as necessary.
This section directs the Secretary, acting through the CDC
and the National Institutes of Health (NIH), in consultation
with the Department of Defense and Department of Veterans
Affairs, to study and report on methods of improving data
collection and collaboration between civilian and military
registries, to include the development of diagnostic tools and
treatments for traumatic brain injuries, within 18 months of
enactment of the Act. It is not the intent of the legislation
to in any way inhibit or supplant the ongoing efforts at the
Departments of Veterans Affairs and Defense in the research,
prevention, and treatment of Traumatic Brain Injury. This
legislation would supplement and compliment the Federal efforts
already underway to address TBI in our Nation's veterans and
service members.
Section 4. Study of traumatic brain injury
Section 4 authorizes the CDC to conduct a study in
consultation with NIH to examine aspects of TBI, including
determining the incidence and prevalence of TBI in all age
groups; collecting, maintaining, and reporting national trends;
identifying interventions used and that can be used for
rehabilitation and their effectiveness; analyzing the adequacy
of existing measures of outcomes and knowledge of factors
influencing differential outcomes; and developing guidelines
for patient rehabilitation after TBI.
The report shall be submitted to Congress no later than 3
years after the date of enactment.
Section 5. Traumatic brain injury programs of the National Institutes
of Health
Section 5 reauthorizes the current grant program for the
conduct of basic and clinical research on trauma, including
diagnosis treatment rehabilitation, and general management of
trauma and TBI.
This section authorizes such sums as may be necessary for
each of the fiscal years 2008 through 2011.
Section 6. Traumatic brain injury programs of the Health Resources and
Services Administration
Section 6 reauthorizes the Secretary to award grants to
States, and authorizes the Secretary to award grants to the
American Indian consortium, for the purpose of carrying out
projects to improve access to health and other services
regarding TBI.
This section authorizes the Secretary to submit to the
committees of jurisdiction no less than biennially, a report
describing the findings, and results of the programs
established under this section.
Definitions in this section include ``American Indian
consortium'' and ``traumatic brain injury''.
Grants are authorized for such sums as may be necessary for
each of the fiscal years 2008 through 2011.
This section authorizes the Secretary to award grants to
protection and advocacy systems for the purpose of enabling
such systems to provide services to individuals with TBI and it
directs those grants to be awarded directly to any protection
and advocacy system that complies with the provisions of this
section, no later than October 1 each fiscal year.
This section requires the Administrator of the Health
Resources and Services Administration and the Commissioner of
the Administration of Developmental Disabilities to enter into
an agreement to coordinate the collection of data by the
Administrator and the Commissioner regarding protection and
advocacy services.
This section requires for any fiscal year for which the
amount appropriated is $6 million or greater, the Administrator
to use 2 percent of such amount to make a grant to an eligible
national association for providing training and technical
assistance for protection and advocacy systems.
In this section, eligible national association means a
national association with demonstrated experience in providing
training and technical assistance to protection and advocacy
systems.
This section clarifies that protection and advocacy systems
are allowed the same authorities as such a system would for the
purpose of providing services under subtitle C of the
Developmental Disabilities Assistance and Bill of Rights Act of
2000, including the authority to pursue legal, administrative,
and other appropriate remedies or approaches to ensure that
protection of, and advocacy for, the rights of such individuals
with a TBI and the authority to provide information and
referral programs and services that address the needs of
individuals with traumatic brain injury.
Changes in Existing Law Made by the Bill, as Reported
In compliance with clause 3(e) of rule XIII of the Rules of
the House of Representatives, changes in existing law made by
the bill, as reported, are shown as follows (existing law
proposed to be omitted is enclosed in black brackets, new
matter is printed in italic, existing law in which no change is
proposed is shown in roman):
PUBLIC HEALTH SERVICE ACT
* * * * * * *
TITLE III--GENERAL POWERS AND DUTIES OF PUBLIC HEALTH SERVICE
* * * * * * *
Part J--Prevention and Control of Injuries
* * * * * * *
SEC. [393B.] 393A. USE OF ALLOTMENTS FOR RAPE PREVENTION EDUCATION.
(a) * * *
* * * * * * *
PREVENTION OF TRAUMATIC BRAIN INJURY
Sec. [393A.] 393B. (a) * * *
(b) Certain Activities.--Activities under subsection (a) may
include--
(1) * * *
* * * * * * *
(3) the implementation of a national education and
awareness campaign regarding such injury (in
conjunction with the program of the Secretary regarding
health-status goals for 2010, commonly referred to as
Healthy People 2010), including--
(A) the national dissemination of information
on--
(i) * * *
(ii) information relating to
traumatic brain injury and the sequelae
of secondary conditions arising from
traumatic brain injury upon discharge
[from hospitals and trauma centers]
from hospitals and emergency
departments; and
* * * * * * *
NATIONAL PROGRAM FOR TRAUMATIC BRAIN INJURY SURVEILLANCE AND REGISTRIES
Sec. [393B.] 393C. (a) In General.--The Secretary, acting
through the Director of the Centers for Disease Control and
Prevention, [may make grants to States or their designees to
operate the State's traumatic brain injury registry, and to
academic institutions to conduct applied research that will
support the development of such registries, to collect data
concerning--] may make grants to States or their designees to
develop or operate the State's traumatic brain injury
surveillance system or registry to determine the incidence and
prevalence of traumatic brain injury and related disability, to
ensure the uniformity of reporting under such system or
registry, to link individuals with traumatic brain injury to
services and supports, and to link such individuals with
academic institutions to conduct applied research that will
support the development of such surveillance systems and
registries as may be necessary. A surveillance system or
registry under this section shall provide for the collection of
data concerning--
(1) * * *
* * * * * * *
(b) Not later than 18 months after the date of enactment of
the Traumatic Brain Injury Act of 2008, the Secretary, acting
through the Director of the Centers for Disease Control and
Prevention and the Director of the National Institutes of
Health and in consultation with the Secretary of Defense and
the Secretary of Veterans Affairs, shall submit to the relevant
committees of Congress a report that contains the findings
derived from an evaluation concerning activities and procedures
that can be implemented by the Centers for Disease Control and
Prevention to improve the collection and dissemination of
compatible epidemiological studies on the incidence and
prevalence of traumatic brain injury in those with traumatic
brain injury who were formerly in the military. The report
shall include recommendations on the manner in which such
agencies can further collaborate on the development and
improvement of traumatic brain injury diagnostic tools and
treatments.
SEC. 393C-1. STUDY ON TRAUMATIC BRAIN INJURY.
(a) Study.--The Secretary, acting through the Director of the
Centers for Disease Control and Prevention with respect to
paragraph (1) and in consultation with the Director of the
National Institutes of Health and other appropriate entities
with respect to paragraphs (2), (3), and (4), may conduct a
study with respect to traumatic brain injury for the purpose of
carrying out the following:
(1) In collaboration with appropriate State and local
health-related agencies--
(A) determining the incidence of traumatic
brain injury and prevalence of traumatic brain
injury related disability and the clinical
aspects of the disability in all age groups and
racial and ethnic minority groups in the
general population of the United States,
including institutional settings, such as
nursing homes, correctional facilities,
psychiatric hospitals, child care facilities,
and residential institutes for people with
developmental disabilities; and
(B) reporting national trends in traumatic
brain injury.
(2) Identifying common therapeutic interventions
which are used for the rehabilitation of individuals
with such injuries, and, subject to the availability of
information, including an analysis of--
(A) the effectiveness of each such
intervention in improving the functioning,
including return to work or school and
community participation, of individuals with
brain injuries;
(B) the comparative effectiveness of
interventions employed in the course of
rehabilitation of individuals with brain
injuries to achieve the same or similar
clinical outcome; and
(C) the adequacy of existing measures of
outcomes and knowledge of factors influencing
differential outcomes.
(3) Identifying interventions and therapies that can
prevent or remediate the development of secondary
neurologic conditions related to traumatic brain
injury.
(4) Developing practice guidelines for the
rehabilitation of traumatic brain injury at such time
as appropriate scientific research becomes available.
(b) Dates Certain for Reports.--If the study is conducted
under subsection (a), the Secretary shall, not later than 3
years after the date of the enactment of the Traumatic Brain
Injury Act of 2008, submit to Congress a report describing
findings made as a result of carrying out such subsection (a).
(c) Definition.--For purposes of this section, the term
``traumatic brain injury'' means an acquired injury to the
brain. Such term does not include brain dysfunction caused by
congenital or degenerative disorders, nor birth trauma, but may
include brain injuries caused by anoxia due to trauma including
near drowning. The Secretary may revise the definition of such
term as the Secretary determines necessary.
* * * * * * *
TITLE XII--TRAUMA CARE
* * * * * * *
Part E--Miscellaneous Programs
* * * * * * *
SEC. 1252. STATE GRANTS FOR PROJECTS REGARDING TRAUMATIC BRAIN INJURY.
(a) In General.--The Secretary, acting through the
Administrator of the Health Resources and Services
Administration, [may make grants to States] may make grants to
States and American Indian consortia for the purpose of
carrying out projects to improve access to [health and other
services] rehabilitation and other services regarding traumatic
brain injury.
(b) State Advisory Board.--
(1) In general.--The Secretary may make a grant under
subsection (a) only if the [State] State or American
Indian consortium involved agrees to establish an
advisory board within the appropriate health department
of the [State] State or American Indian consortium or
within another department as designated by the chief
executive officer of the [State] State or American
Indian consortium.
(2) Functions.--An advisory board established under
paragraph (1) shall advise and make [recommendations to
the State] recommendations to the State or American
Indian consortium on ways to improve services
coordination regarding traumatic brain injury. Such
advisory boards shall encourage citizen participation
through the establishment of public hearings and other
types of community outreach programs. In developing
recommendations under this paragraph, such boards shall
consult with Federal, State, and local governmental
agencies and with citizens groups and other private
entities.
(3) Composition.--An advisory board established under
paragraph (1) shall be composed of--
(A) representatives of--
(i) the corresponding [State] State
or American Indian consortium agencies
involved;
* * * * * * *
(iii) other disability advisory or
planning groups within the [State]
State or American Indian consortium;
(iv) members of an organization or
foundation representing individuals
with traumatic brain injury in that
[State] State or American Indian
consortium; and
* * * * * * *
(c) Matching Funds.--
(1) In general.--With respect to the costs to be
incurred by a [State] State or American Indian
consortium in carrying out the purpose described in
subsection (a), the Secretary may make a grant under
such subsection only if the [State] State or American
Indian consortium agrees to make available non-Federal
contributions toward such costs in an amount that is
not less than $1 for each $2 of Federal funds provided
under the grant.
* * * * * * *
(e) Continuation of Previously Awarded Demonstration
Projects.--[A State that received a grant under this section
prior to the date of the enactment of the Children's Health Act
of 2000 may compete for new project grants under this section
after such date of the enactment.] A State or American Indian
consortium that received a grant under this section prior to
the date of the enactment of the Traumatic Brain Injury Act of
2008 may complete the activities funded by the grant.
(f) Use of State and American Indian Consortium Grants.--
(1) Community services and supports.--A [State] State
or American Indian consortium shall (directly or
through awards of contracts to nonprofit private
entities) use amounts received under a grant under this
section for the following:
(A) To develop, change, or enhance community-
based service delivery systems that include
timely access to comprehensive appropriate
services and supports. Such service and
supports--
(i) * * *
(ii) shall be designed for [children
and other individuals] children, youth,
and adults with traumatic brain injury.
* * * * * * *
(E) To support other needs identified by the
advisory board under subsection (b) for the
[State] State or American Indian consortium
involved.
(2) Best practices.--
(A) In general.--[State] State or American
Indian consortium services and supports
provided under a grant under this section shall
reflect the best practices in the field of
traumatic brain injury, shall be in compliance
with title II of the Americans with
Disabilities Act of 1990, and shall be
supported by quality assurance measures as well
as state-of-the-art health care and integrated
community supports, regardless of the severity
of injury.
(B) Demonstration by state agency.--The
[State] State or American Indian consortium
agency responsible for administering amounts
received under a grant under this section shall
demonstrate that it has obtained knowledge and
expertise of traumatic brain injury and the
unique needs associated with traumatic brain
injury.
(3) State capacity building.--A [State] State or
American Indian consortium may use amounts received
under a grant under this section to--
(A) * * *
* * * * * * *
(E) tailor existing [State] State or American
Indian consortium systems to provide
accommodations to the needs of individuals with
brain injury (including systems administered by
the [State] State or American Indian consortium
departments responsible for health, mental
health, labor/employment, education, mental
retardation /developmental disorders,
transportation, and correctional systems);
(F) improve data sets coordinated across
systems and other needs identified by a [State]
State or American Indian consortium plan
supported by its advisory council; and
* * * * * * *
(h) Report.--[Not later than 2 years after the date of the
enactment of this section, the Secretary] Not less than
biennially, the Secretary shall submit to the Committee on
[Commerce of the House of Representatives, and to the Committee
on Labor and Human Resources] Energy and Commerce of the House
of Representatives, and to the Committee on Health, Education,
Labor, and Pensions of the Senate, a report describing the
findings and results of the programs established under this
section, and section 1253 including measures of outcomes and
consumer and surrogate satisfaction.
[(i) Definition.--For purposes of this section, the term
``traumatic brain injury'' means an acquired injury to the
brain. Such term does not include brain dysfunction caused by
congenital or degenerative disorders, nor birth trauma, but may
include brain injuries caused by anoxia due to trauma. The
Secretary may revise the definition of such term as the
Secretary determines necessary, after consultation with States
and other appropriate public or nonprofit private entities.]
(i) Definitions.--For purposes of this section:
(1) The terms ``American Indian consortium'' and
``State'' have the meanings given to those terms in
section 1253.
(2) The term ``traumatic brain injury'' means an
acquired injury to the brain. Such term does not
include brain dysfunction caused by congenital or
degenerative disorders, nor birth trauma, but may
include brain injuries caused by anoxia due to trauma.
The Secretary may revise the definition of such term as
the Secretary determines necessary, after consultation
with States and other appropriate public or nonprofit
private entities.
(j) Authorization of Appropriations.--For the purpose of
carrying out this section, there are authorized to be
appropriated such sums as may be necessary for each of the
fiscal years 2001 through 2005, and such sums as may be
necessary for each of the fiscal years 2009 through 2012.
SEC. 1253. STATE GRANTS FOR PROTECTION AND ADVOCACY SERVICES.
(a) * * *
* * * * * * *
(d) Appropriations Less Than $2,700,000.--
(1) In general.--With respect to any fiscal year in
which the amount appropriated under [subsection (i)]
subsection (l) to carry out this section is less than
$2,700,000, the Administrator shall make grants from
such amount to individual protection and advocacy
systems within States to enable such systems to plan
for, develop outreach strategies for, and carry out
services authorized under this section for individuals
with traumatic brain injury.
* * * * * * *
(e) Appropriations of $2,700,000 or More.--
(1) Population basis.--Except as provided in
paragraph (2), with respect to each fiscal year in
which the amount appropriated under [subsection (i)]
subsection (l) to carry out this section is $2,700,000
or more, the Administrator shall make a grant to a
protection and advocacy system within each State.
(2) Amount.--The amount of a grant provided to a
system under paragraph (1) shall be equal to an amount
bearing the same ratio to the total amount appropriated
for the fiscal year involved under [subsection (i)]
subsection (l) as the population of the State in which
the grantee is located bears to the population of all
States.
* * * * * * *
(4) Inflation adjustment.--For each fiscal year in
which the total amount appropriated under [subsection
(i)] subsection (l) to carry out this section is
$5,000,000 or more, and such appropriated amount
exceeds the total amount appropriated to carry out this
section in the preceding fiscal year, the Administrator
shall increase each of the minimum grants amount
described in subparagraphs (A) and (B) of paragraph (3)
by a percentage equal to the percentage increase in the
total amount appropriated under [subsection (i)]
subsection (l) to carry out this section between the
preceding fiscal year and the fiscal year involved.
* * * * * * *
(g) Direct Payment.--Notwithstanding any other provision of
law, each fiscal year not later than October 1, the
Administrator shall pay directly to any protection and advocacy
system that complies with the provisions of this section, the
total amount of the grant for such system, unless the system
provides otherwise for such payment.
* * * * * * *
(i) Data Collection.--The Administrator of the Health
Resources and Services Administration and the Commissioner of
the Administration on Developmental Disabilities shall enter
into an agreement to coordinate the collection of data by the
Administrator and the Commissioner regarding protection and
advocacy services.
(j) Training and Technical Assistance.--
(1) Grants.--For any fiscal year for which the amount
appropriated to carry out this section is $6,000,000 or
greater, the Administrator shall use 2 percent of such
amount to make a grant to an eligible national
association for providing for training and technical
assistance to protection and advocacy systems.
(2) Definition.--In this subsection, the term
``eligible national association'' means a national
association with demonstrated experience in providing
training and technical assistance to protection and
advocacy systems.
(k) System Authority.--In providing services under this
section, a protection and advocacy system shall have the same
authorities, including access to records, as such system would
have for purposes of providing services under subtitle C of the
Developmental Disabilities Assistance and Bill of Rights Act of
2000.
[(i)] (l) Authorization of Appropriations.--There are
authorized to be appropriated to carry out this section
$5,000,000 for fiscal year 2001, and such sums as may be
necessary for each the fiscal years [2002 through 2005] 2009
through 2012.
[(j)] (m) Definitions.--In this section:
(1) * * *
* * * * * * *
Part F--Interagency Program for Trauma Research
SEC. 1261. ESTABLISHMENT OF PROGRAM.
(a) * * *
(b) Plan for Program.--
(1) * * *
(2) Submission to congress.--Not later than December
1, 1993, the Director shall submit the plan required in
paragraph (1) to the Committee on Energy and Commerce
of the House of Representatives, and to the Committee
on [Labor and Human Resources] Health, Education,
Labor, and Pensions of the Senate, together with an
estimate of the funds needed for each of the fiscal
years 1994 through 1996 to implement the plan.
* * * * * * *
(d) Certain Activities of Program.--The Program shall
include--
(1) * * *
* * * * * * *
(4) the authority to make awards of grants or
contracts to public or nonprofit private entities for
the conduct of basic and applied research regarding
traumatic brain injury, which research may include--
(A) * * *
* * * * * * *
(D) the development of programs that increase
the participation of academic centers of
excellence in [head brain injury] brain injury
treatment and rehabilitation research and
training; and
* * * * * * *
(i) Authorization of Appropriations.--For the purpose of
carrying out this section, there are authorized to be
appropriated such sums as may be necessary for each of the
fiscal years 2001 through 2005, and such sums as may be
necessary for each of the fiscal years 2009 through 2012.
* * * * * * *
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