[DOCID: f:hr077.110]
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110th Congress Report
HOUSE OF REPRESENTATIVES
1st Session 110-77
======================================================================
TRAUMA CARE SYSTEMS PLANNING AND DEVELOPMENT ACT OF 2007
_______
March 27, 2007.--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. 727]
[Including cost estimate of the Congressional Budget Office]
The Committee on Energy and Commerce, to whom was referred
the bill (H.R. 727) to amend the Public Health Service Act to
add requirements regarding trauma care, and for other purposes,
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.............................................. 7
Background and Need for Legislation.............................. 7
Hearings......................................................... 8
Committee Consideration.......................................... 8
Committee Votes.................................................. 8
Committee Oversight Findings..................................... 8
Statement of General Performance Goals and Objectives............ 8
New Budget Authority, Entitlement Authority, and Tax Expenditures 9
Earmarks and Tax and Tariff Benefits............................. 9
Committee Cost Estimate.......................................... 9
Congressional Budget Office Estimate............................. 9
Federal Mandates Statement....................................... 11
Advisory Committee Statement..................................... 11
Constitutional Authority Statement............................... 11
Applicability to Legislative Branch.............................. 11
Section-by-Section Analysis of the Legislation................... 11
Changes in Existing Law Made by the Bill, as Reported............ 13
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 ``Trauma Care Systems Planning and
Development Act of 2007''.
SEC. 2. ESTABLISHMENT.
Section 1201 of the Public Health Service Act (42 U.S.C. 300d) is
amended to read as follows:
``SEC. 1201. ESTABLISHMENT.
``(a) In General.--The Secretary shall, with respect to trauma care--
``(1) conduct and support research, training, evaluations,
and demonstration projects;
``(2) foster the development of appropriate, modern systems
of such care through the sharing of information among agencies
and individuals involved in the study and provision of such
care;
``(3) collect, compile, and disseminate information on the
achievements of, and problems experienced by, State and local
agencies and private entities in providing trauma care and
emergency medical services and, in so doing, give special
consideration to the unique needs of rural areas;
``(4) provide to State and local agencies technical
assistance to enhance each State's capability to develop,
implement, and sustain the trauma care component of each
State's plan for the provision of emergency medical services;
``(5) sponsor workshops and conferences; and
``(6) promote the collection and categorization of trauma
data in a consistent and standardized manner.
``(b) Grants, Cooperative Agreements, and Contracts.--The Secretary
may make grants, and enter into cooperative agreements and contracts,
for the purpose of carrying out subsection (a).''.
SEC. 3. CLEARINGHOUSE ON TRAUMA CARE AND EMERGENCY MEDICAL SERVICES.
The Public Health Service Act (42 U.S.C. 201 et seq.) is amended--
(1) by striking section 1202; and
(2) by redesignating section 1203 as section 1202.
SEC. 4. ESTABLISHMENT OF PROGRAMS FOR IMPROVING TRAUMA CARE IN RURAL
AREAS.
Section 1202 of the Public Health Service Act, as redesignated by
section 3(2), is amended to read as follows:
``SEC. 1202. ESTABLISHMENT OF PROGRAMS FOR IMPROVING TRAUMA CARE IN
RURAL AREAS.
``(a) In General.--The Secretary may make grants to public and
nonprofit private entities for the purpose of carrying out research and
demonstration projects with respect to improving the availability and
quality of emergency medical services in rural areas--
``(1) by developing innovative uses of communications
technologies and the use of new communications technology;
``(2) by developing model curricula, such as advanced trauma
life support, for training emergency medical services
personnel, including first responders, emergency medical
technicians, emergency nurses and physicians, and paramedics--
``(A) in the assessment, stabilization, treatment,
preparation for transport, and resuscitation of
seriously injured patients, with special attention to
problems that arise during long transports and to
methods of minimizing delays in transport to the
appropriate facility; and
``(B) in the management of the operation of the
emergency medical services system;
``(3) by making training for original certification, and
continuing education, in the provision and management of
emergency medical services more accessible to emergency medical
personnel in rural areas through telecommunications, home
studies, providing teachers and training at locations
accessible to such personnel, and other methods;
``(4) by developing innovative protocols and agreements to
increase access to prehospital care and equipment necessary for
the transportation of seriously injured patients to the
appropriate facilities;
``(5) by evaluating the effectiveness of protocols with
respect to emergency medical services and systems; and
``(6) by increasing communication and coordination with State
trauma systems.
``(b) Special Consideration for Certain Rural Areas.--In making
grants under subsection (a), the Secretary shall give special
consideration to any applicant for the grant that will provide services
under the grant in any rural area identified by a State under section
1214(d)(1).
``(c) Requirement of Application.--The Secretary may not make a grant
under subsection (a) unless an application for the grant is submitted
to the Secretary and the application is in such form, is made in such
manner, and contains such agreements, assurances, and information as
the Secretary determines to be necessary to carry out this section.''.
SEC. 5. COMPETITIVE GRANTS.
Part A of title XII of the Public Health Service Act, as amended by
section 3, is amended by adding at the end the following:
``SEC. 1203. COMPETITIVE GRANTS FOR THE IMPROVEMENT OF TRAUMA CARE.
``(a) In General.--The Secretary, acting through the Administrator of
the Health Resources and Services Administration, may make grants to
States, political subdivisions, or consortia of States or political
subdivisions for the purpose of improving access to and enhancing the
development of trauma care systems.
``(b) Use of Funds.--The Secretary may make a grant under this
section only if the applicant agrees to use the grant--
``(1) to integrate and broaden the reach of a trauma care
system, such as by developing innovative protocols to increase
access to prehospital care;
``(2) to strengthen, develop, and improve an existing trauma
care system;
``(3) to expand communications between the trauma care system
and emergency medical services through improved equipment or a
telemedicine system;
``(4) to improve data collection and retention; or
``(5) to increase education, training, and technical
assistance opportunities, such as training and continuing
education in the management of emergency medical services
accessible to emergency medical personnel in rural areas
through telehealth, home studies, and other methods.
``(c) Preference.--In selecting among States, political subdivisions,
and consortia of States or political subdivisions for purposes of
making grants under this section, the Secretary shall give preference
to applicants that--
``(1) have developed a process, using national standards, for
designating trauma centers;
``(2) recognize protocols for the delivery of seriously
injured patients to trauma centers;
``(3) implement a process for evaluating the performance of
the trauma system; and
``(4) agree to participate in information systems described
in section 1202 by collecting, providing, and sharing
information.
``(d) Priority.--In making grants under this section, the Secretary
shall give priority to applicants that will use the grants to focus on
improving access to trauma care systems.
``(e) Special Consideration.--In awarding grants under this section,
the Secretary shall give special consideration to projects that
demonstrate strong State or local support, including availability of
non-Federal contributions.''.
SEC. 6. REQUIREMENT OF MATCHING FUNDS FOR FISCAL YEARS SUBSEQUENT TO
FIRST FISCAL YEAR OF PAYMENTS.
Section 1212 of the Public Health Service Act (42 U.S.C. 300d-12) is
amended to read as follows:
``SEC. 1212. REQUIREMENT OF MATCHING FUNDS FOR FISCAL YEARS SUBSEQUENT
TO FIRST FISCAL YEAR OF PAYMENTS.
``(a) Non-Federal Contributions.--
``(1) In general.--The Secretary may not make payments under
section 1211(a) unless the State involved agrees, with respect
to the costs described in paragraph (2), to make available non-
Federal contributions (in cash or in kind under subsection
(b)(1)) toward such costs in an amount that--
``(A) for the second and third fiscal years of such
payments to the State, is not less than $1 for each $1
of Federal funds provided in such payments for such
fiscal years; and
``(B) for the fourth and subsequent fiscal years of
such payments to the State, is not less than $2 for
each $1 of Federal funds provided in such payments for
such fiscal years.
``(2) Program costs.--The costs referred to in paragraph (1)
are--
``(A) the costs to be incurred by the State in
carrying out the purpose described in section 1211(b);
or
``(B) the costs of improving the quality and
availability of emergency medical services in rural
areas of the State.
``(3) Initial year of payments.--The Secretary may not
require a State to make non-Federal contributions as a
condition of receiving payments under section 1211(a) for the
first fiscal year of such payments to the State.
``(b) Determination of Amount of Non-Federal Contribution.--With
respect to compliance with subsection (a) as a condition of receiving
payments under section 1211(a)--
``(1) a State may make the non-Federal contributions required
in such subsection in cash or in kind, fairly evaluated,
including plant, equipment, or services; and
``(2) the Secretary may not, in making a determination of the
amount of non-Federal contributions, include amounts provided
by the Federal Government or services assisted or subsidized to
any significant extent by the Federal Government.''.
SEC. 7. REQUIREMENTS WITH RESPECT TO CARRYING OUT PURPOSE OF
ALLOTMENTS.
Section 1213 of the Public Health Service Act (42 U.S.C. 300d-13) is
amended to read as follows:
``SEC. 1213. REQUIREMENTS WITH RESPECT TO CARRYING OUT PURPOSE OF
ALLOTMENTS.
``(a) Trauma Care Modifications to State Plan for Emergency Medical
Services.--With respect to the trauma care component of a State plan
for the provision of emergency medical services, the modifications
referred to in section 1211(b) are such modifications to the State plan
as may be necessary for the State involved to ensure that the plan
provides for access to the highest possible quality of trauma care, and
that the plan--
``(1) specifies that the modifications required pursuant to
paragraphs (2) through (11) will be implemented by the
principal State agency with respect to emergency medical
services or by the designee of such agency;
``(2) specifies a public or private entity that will
designate trauma care regions and trauma centers in the State;
``(3) subject to subsection (b), contains national standards
and requirements of the American College of Surgeons or another
appropriate entity for the designation of level I and level II
trauma centers, and in the case of rural areas level III trauma
centers (including trauma centers with specified capabilities
and expertise in the care of pediatric trauma patients), by
such entity, including standards and requirements for--
``(A) the number and types of trauma patients for
whom such centers must provide care in order to ensure
that such centers will have sufficient experience and
expertise to be able to provide quality care for
victims of injury;
``(B) the resources and equipment needed by such
centers; and
``(C) the availability of rehabilitation services for
trauma patients;
``(4) contains standards and requirements for the
implementation of regional trauma care systems, including
standards and guidelines (consistent with the provisions of
section 1867 of the Social Security Act) for medically directed
triage and transportation of trauma patients (including
patients injured in rural areas) prior to care in designated
trauma centers;
``(5) subject to subsection (b), contains national standards
and requirements, including those of the American Academy of
Pediatrics and the American College of Emergency Physicians,
for medically directed triage and transport of severely injured
children to designated trauma centers with specified
capabilities and expertise in the care of pediatric trauma
patients;
``(6) utilizes a program with procedures for the evaluation
of designated trauma centers (including trauma centers
described in paragraph (5)) and trauma care systems;
``(7) provides for the establishment and collection of data
in accordance with data collection requirements developed in
consultation with surgical, medical, and nursing specialty
groups, State and local emergency medical services directors,
and other trained professionals in trauma care, from each
designated trauma center in the State of a central data
reporting and analysis system--
``(A) to identify the number of severely injured
trauma patients and the number of deaths from trauma
within trauma care systems in the State;
``(B) to identify the cause of the injury and any
factors contributing to the injury;
``(C) to identify the nature and severity of the
injury;
``(D) to monitor trauma patient care (including
prehospital care) in each designated trauma center
within regional trauma care systems in the State
(including relevant emergency-department discharges and
rehabilitation information) for the purpose of
evaluating the diagnosis, treatment, and treatment
outcome of such trauma patients;
``(E) to identify the total amount of uncompensated
trauma care expenditures for each fiscal year by each
designated trauma center in the State; and
``(F) to identify patients transferred within a
regional trauma system, including reasons for such
transfer and the outcomes of such patients;
``(8) provides for the use of procedures by paramedics and
emergency medical technicians to assess the severity of the
injuries incurred by trauma patients;
``(9) provides for appropriate transportation and transfer
policies to ensure the delivery of patients to designated
trauma centers and other facilities within and outside of the
jurisdiction of such system, including policies to ensure that
only individuals appropriately identified as trauma patients
are transferred to designated trauma centers, and to provide
periodic reviews of the transfers and the auditing of such
transfers that are determined to be appropriate;
``(10) conducts public education activities concerning injury
prevention and obtaining access to trauma care;
``(11) coordinates planning for trauma systems with State
disaster emergency planning and bioterrorism hospital
preparedness planning; and
``(12) with respect to the requirements established in this
subsection, provides for coordination and cooperation between
the State and any other State with which the State shares any
standard metropolitan statistical area.
``(b) Certain Standards With Respect to Trauma Care Centers and
Systems.--
``(1) In general.--The Secretary may not make payments under
section 1211(a) for a fiscal year unless the State involved
agrees that, in carrying out paragraphs (3) through (5) of
subsection (a), the State will adopt standards for the
designation of trauma centers, and for triage, transfer, and
transportation policies, and that the State will, in adopting
such standards--
``(A) take into account national standards that
outline resources for optimal care of injured patients;
``(B) consult with medical, surgical, and nursing
speciality groups, hospital associations, emergency
medical services State and local directors, concerned
advocates, and other interested parties;
``(C) conduct hearings on the proposed standards
after providing adequate notice to the public
concerning such hearing; and
``(D) beginning in fiscal year 2008, take into
account the model plan described in subsection (c).
``(2) Quality of trauma care.--The highest quality of trauma
care shall be the primary goal of State standards adopted under
this subsection.
``(3) Approval by the secretary.--The Secretary may not make
payments under section 1211(a) to a State if the Secretary
determines that--
``(A) in the case of payments for fiscal year 2008
and subsequent fiscal years, the State has not taken
into account national standards, including those of the
American College of Surgeons, the American College of
Emergency Physicians, and the American Academy of
Pediatrics, in adopting standards under this
subsection; or
``(B) in the case of payments for fiscal year 2008
and subsequent fiscal years, the State has not, in
adopting such standards, taken into account the model
plan developed under subsection (c).
``(c) Model Trauma Care Plan.--
``(1) In general.--Not later than 1 year after the date of
the enactment of the Trauma Care Systems Planning and
Development Act of 2007, the Secretary shall update the model
plan for the designation of trauma centers and for triage,
transfer, and transportation policies that may be adopted for
guidance by the State. Such plan shall--
``(A) take into account national standards, including
those of the American College of Surgeons, American
College of Emergency Physicians, and the American
Academy of Pediatrics;
``(B) take into account existing State plans;
``(C) be developed in consultation with medical,
surgical, and nursing speciality groups, hospital
associations, emergency medical services State
directors and associations, and other interested
parties; and
``(D) include standards for the designation of rural
health facilities and hospitals best able to receive,
stabilize, and transfer trauma patients to the nearest
appropriate designated trauma center, and for triage,
transfer, and transportation policies as they relate to
rural areas.
``(2) Applicability.--Standards described in paragraph (1)(D)
shall be applicable to all rural areas in the State, including
both non-metropolitan areas and frontier areas that have
populations of less than 6,000 per square mile.
``(d) Rule of Construction With Respect to Number of Designated
Trauma Centers.--With respect to compliance with subsection (a) as a
condition of the receipt of a grant under section 1211(a), such
subsection may not be construed to specify the number of trauma care
centers designated pursuant to such subsection.''.
SEC. 8. REQUIREMENT OF SUBMISSION TO SECRETARY OF TRAUMA PLAN AND
CERTAIN INFORMATION.
Section 1214 of the Public Health Service Act (42 U.S.C. 300d-14) is
amended to read as follows:
``SEC. 1214. REQUIREMENT OF SUBMISSION TO SECRETARY OF TRAUMA PLAN AND
CERTAIN INFORMATION.
``(a) In General.--For each fiscal year, the Secretary may not make
payments to a State under section 1211(a) unless, subject to subsection
(b), the State submits to the Secretary the trauma care component of
the State plan for the provision of emergency medical services,
including any changes to the trauma care component and any plans to
address deficiencies in the trauma care component.
``(b) Interim Plan or Description of Efforts.--For each fiscal year,
if a State has not completed the trauma care component of the State
plan described in subsection (a), the State may provide, in lieu of
such completed component, an interim component or a description of
efforts made toward the completion of the component.
``(c) Information Received by State Reporting and Analysis System.--
The Secretary may not make payments to a State under section 1211(a)
unless the State agrees that the State will, not less than once each
year, provide to the Secretary the information received by the State
pursuant to section 1213(a)(7).
``(d) Availability of Emergency Medical Services in Rural Areas.--The
Secretary may not make payments to a State under section 1211(a)
unless--
``(1) the State identifies any rural area in the State for
which--
``(A) there is no system of access to emergency
medical services through the telephone number 911;
``(B) there is no basic life-support system; or
``(C) there is no advanced life-support system; and
``(2) the State submits to the Secretary a list of rural
areas identified pursuant to paragraph (1) or, if there are no
such areas, a statement that there are no such areas.''.
SEC. 9. RESTRICTIONS ON USE OF PAYMENTS.
Section 1215 of the Public Health Service Act (42 U.S.C. 300d-15) is
amended to read as follows:
``SEC. 1215. RESTRICTIONS ON USE OF PAYMENTS.
``(a) In General.--The Secretary may not, except as provided in
subsection (b), make payments under section 1211(a) for a fiscal year
unless the State involved agrees that the payments will not be
expended--
``(1) for any purpose other than developing, implementing,
and monitoring the modifications required by section 1211(b) to
be made to the State plan for the provision of emergency
medical services;
``(2) to make cash payments to intended recipients of
services provided pursuant to this section;
``(3) to purchase or improve real property (other than minor
remodeling of existing improvements to real property);
``(4) to satisfy any requirement for the expenditure of non-
Federal funds as a condition for the receipt of Federal funds;
or
``(5) to provide financial assistance to any entity other
than a public or nonprofit private entity.
``(b) Waiver.--The Secretary may waive a restriction under subsection
(a) only if the Secretary determines that the activities outlined by
the State plan submitted under section 1214(a) by the State involved
cannot otherwise be carried out.''.
SEC. 10. REQUIREMENTS OF REPORTS BY STATES.
The Public Health Service Act (42 U.S.C. 201 et seq.) is amended by
striking section 1216.
SEC. 11. REPORT BY SECRETARY.
Section 1222 of the Public Health Service Act (42 U.S.C. 300d-22) is
amended to read as follows:
``SEC. 1222. REPORT BY SECRETARY.
``Not later than October 1, 2008, the Secretary shall report to the
appropriate committees of Congress on the activities of the States
carried out pursuant to section 1211. Such report shall include an
assessment of the extent to which Federal and State efforts to develop
systems of trauma care and to designate trauma centers have reduced the
incidence of mortality, and the incidence of permanent disability,
resulting from trauma. Such report may include any recommendations of
the Secretary for appropriate administrative and legislative
initiatives with respect to trauma care.''.
SEC. 12. FUNDING.
Section 1232 of the Public Health Service Act (42 U.S.C. 300d-32) is
amended to read as follows:
``SEC. 1232. FUNDING.
``(a) Authorization of Appropriations.--For the purpose of carrying
out parts A and B, subject to subsections (b) and (c), there are
authorized to be appropriated $12,000,000 for fiscal year 2008,
$10,000,000 for fiscal year 2009, and $8,000,000 for each of the fiscal
years 2010 through 2012.
``(b) Reservation of Funds.--If the amount appropriated under
subsection (a) for a fiscal year is equal to or less than $1,000,000,
such appropriation is available only for the purpose of carrying out
part A. If the amount so appropriated is greater than $1,000,000, 50
percent of such appropriation shall be made available for the purpose
of carrying out part A and 50 percent shall be made available for the
purpose of carrying out part B.
``(c) Allocation of Part A Funds.--Of the amounts appropriated under
subsection (a) for a fiscal year to carry out part A--
``(1) 10 percent of such amounts for such year shall be
allocated for administrative purposes; and
``(2) 10 percent of such amounts for such year shall be
allocated for the purpose of carrying out section 1202.''.
SEC. 13. RESIDENCY TRAINING PROGRAMS IN EMERGENCY MEDICINE.
Section 1251 of the Public Health Service Act (42 U.S.C. 300d-51) is
amended to read as follows:
``SEC. 1251. RESIDENCY TRAINING PROGRAMS IN EMERGENCY MEDICINE.
``(a) In General.--The Secretary may make grants to public and
nonprofit private entities for the purpose of planning and developing
approved residency training programs in emergency medicine.
``(b) Identification and Referral of Domestic Violence.--The
Secretary may make a grant under subsection (a) only if the applicant
involved agrees that the training programs under subsection (a) will
provide education and training in identifying and referring cases of
domestic violence.
``(c) Authorization of Appropriations.--For the purpose of carrying
out this section, there is authorized to be appropriated $400,000 for
each of the fiscal years 2008 though 2012.''.
SEC. 14. STATE GRANTS FOR CERTAIN PROJECTS.
Section 1252 of the Public Health Service Act (42 U.S.C. 300d-52) is
amended in the section heading by striking ``DEMONSTRATION''.
Purpose and Summary
The purpose of H.R. 727, the Trauma Care Systems Planning
and Development Act of 2007, is to amend the Public Health
Service Act to add requirements regarding trauma care, and for
other purposes. The legislation would reauthorize title XII of
the Public Health Service Act for a period of 5 years to
establish formula and competitive grants for the purpose of
planning, implementing, and developing statewide trauma care
systems.
Background and Need for Legislation
Traumatic injury is one of the most important public health
problems facing the United States. Each year more than 150,000
Americans die from traumatic injuries, another two million
people are seriously injured. Trauma and injury are leading
causes of death and disability of Americans between the ages of
1 and 44 years, the third leading cause of death in the general
population of the United States. Most traumatic injury is due
to motor vehicle collisions, violence, and falls.
A trauma care system is an organized approach to
facilitating and coordinating a response to traumatic injury
for severely injured patients. This multidisciplinary approach
includes injury prevention, emergency transport, emergency
department care, surgical intervention, hospital care,
rehabilitative services and social services that enable the
patient to return to society at the most productive level.
Adequate and timely trauma care is life sustaining for the
severely injured patients.
Both death and disability for severely injured patients are
reduced drastically when definitive, timely trauma care is
provided. Inadequate systems of trauma care at both the
community and hospital levels, as well as inequities in access
to prehospital and hospital emergency services contribute to
high rates of death and disability, particularly in rural and
medically underserved areas. According to a 2004 study of the
National Center for Injury Prevention and Control at the
Centers for Disease Control and Prevention, as many as 35
percent of trauma patients' deaths could have been prevented if
optimal acute care had been available.
Trauma care systems are vital to our Nation's public health
and emergency preparedness infrastructure. Strengthening title
XII programs governing trauma care system planning and
development will help to enhance disaster preparedness and
reduce death and disability for those experiencing traumatic
injury.
Hearings
The Committee on Energy and Commerce has not held hearings
on the legislation.
Committee Consideration
On Tuesday, March 13, 2007, the Subcommittee on Health met
in open markup session and approved H.R. 727 for full Committee
consideration, amended, by voice vote. On Thursday, March 15,
2007, the full Committee met in open markup session and ordered
H.R. 727 favorably reported to the House, as amended, by voice
vote.
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. 727 reported. A motion by Mr. Dingell to
order H.R. 727 favorably reported to the House, amended, was
agreed to by voice vote.
Committee Oversight Findings
Regarding clause 3(c)(1) of rule XIII of the Rules of the
House of Representatives, the Committee has not held oversight
or legislative hearings on this legislation.
Statement of General Performance Goals and Objectives
The goals and objectives of H.R. 727 are to improve
emergency medical services to ensure that severely injured
patients receive prompt trauma care, thereby reducing the rates
of lifelong traumatic injuries and death. Particular emphasis
is placed on improving trauma care systems in rural areas,
which disproportionately experience challenges in communication
and coordination with State trauma 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. 727 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. 727 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 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
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, March 19, 2007.
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. 727, the Trauma
Care Systems Planning and Development Act of 2007.
If you wish further details on this estimate, we will be
pleased to provide them. The CBO staff contact is Camile
Williams.
Sincerely,
Peter R. Orszag,
Director.
Enclosure.
H.R. 727--Trauma Care Systems Planning and Development Act of 2007
Summary: H.R. 727 would amend the Public Health Service Act
to authorize several emergency services and trauma care
programs administered by the Health Resources and Services
Administration (HRSA). The trauma care programs include grants
and cooperative agreements to assist states in the improvement
and development of trauma care systems and emergency care
residency training programs.
Assuming that the specified amounts are appropriated for
fiscal years 2008 through 2012, CBO estimates that implementing
H.R. 727 would cost $40 million over the 2008-2012 period. The
legislation would not affect direct spending or receipts.
H.R. 727 contains no intergovernmental or private-sector
mandates as defined in the Unfunded Mandates Reform Act (UMRA)
and would benefit states. The bill would authorize grant
programs designed to improve the quality of trauma care
systems. States that choose to apply for those grants would
have to provide matching funds, but any costs they face would
be incurred voluntarily.
Estimated cost to the Federal Government: The estimated
budgetary impact of H.R. 727 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
----------------------------------------------------------------------------------------------------------------
CHANGES IN SPENDING SUBJECT TO APPROPRIATION
Authorization Level................................................ 12 10 8 8 8
Estimated Outlays.................................................. 5 10 9 8 8
----------------------------------------------------------------------------------------------------------------
Basis of estimate: H.R. 727 would authorize the
appropriation of $12 million in fiscal year 2008, $10 million
in 2009, and $8 million in each of fiscal years 2010 through
2012 for trauma-related grant programs. The bill also would
authorize the appropriation of $400,000 a year for grants to
plan and develop residency programs in emergency medicine.
Based on spending patterns for similar grant programs (which
were funded through 2006, and assuming authorization of
specified amounts, CBO estimates that implementing H.R. 727
would cost $5 million in 2008 and $40 million over the 2008-
2012 period.
The bill would authorize HRSA to make grants to states for
the planning, development, and improvement of trauma care
centers and systems. H.R. 727 also would authorize HRSA to make
grants to public and private nonprofit entities to improve
access to trauma care and to conduct research and demonstration
projects to improve the availability and quality of emergency
medical services in rural areas.
The planning grant part of the program provides federal
matching payments to funds spent by states. The federal
government would provide $1 for every $1 of state spending in
the second and third year and $1 for every $2 of state spending
in the fourth and subsequent years. The grants to public or
provide nonprofit agencies would not require matching payment
by those agencies. CBO estimates that implementing the grant
program would cost $5 million in 2008 and $38 million over the
2008-2012 period, assuming the appropriation of the specified
amounts.
The grants for residency training programs in emergency
medicine would provide funding to public and private nonprofit
entities to develop residency program with an emphasis on
treatment and referral of domestic violence cases. CBO
estimates that implementing this provision would cost $2
million over the 2008-2012 period.
Intergovernmental and private-sector impact: The bill
contains no intergovernmental or private-sector mandates as
defined in UMRA and would impose on costs on state, local, or
tribal governments. The bill would authorize grant programs
designed to improve the quality of trauma care systems. States
that choose to apply for those grants would have to provide
matching funds, but any costs they face would be incurred
voluntarily.
Estimate prepared by: Federal Costs: Camile Williams.
Impact on State, Local, and Tribal Governments: Leo Lex. Impact
on the Private Sector: Paige Shevlin.
Estimate approved by: Peter H. Fontaine, Deputy Assistant
Director for Budget Analysis.
Federal Mandates Statement
The Committee adopts as its own the estimate of Federal
mandates 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 were created by this
legislation.
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 this legislation 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 the legislation 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.
Section-by-Section Analysis of the Legislation
Section 1. Short title
Section 1 establishes the short title as the ``Trauma Care
Systems Planning and Development Act of 2007.''
Section 2. Establishment
Section 2 amends the Public Health Service Act to direct
the Secretary of Health and Human Services, either directly or
through cooperative agreement and contract, to promote and
enhance a State's capacity with respect to trauma care through
information sharing, technical assistance, data collection, and
workshops and conferences.
Section 3. Clearinghouse on Trauma Care and Emergency Medical Services
Section 3 strikes the section that relates to the National
Clearinghouse on Trauma Care and Emergency Medical Services.
Section 4. Establishment of programs for improving trauma care in rural
areas
Section 4 allows the Secretary to make grants to entities
to carry out demonstration projects to improve emergency
medical services in rural areas by increasing communication and
coordination with state trauma systems.
Section 5. Competitive grants
Section 5 allows the Secretary, acting through the
Administrator of the Health Resources and Services
Administration, to make grants to States, political
subdivisions, or consortia of States or political subdivisions
to improve access to and enhance the development of trauma care
system.
Section 6. Requirements of matching funds for fiscal years subsequent
to first fiscal year of payments
Section 6 revises the matching requirements for States to
be eligible for grants so that a State increases its share of
non-Federal contribution (in cash and in kind), in subsequent
fiscal years.
Section 7. Requirements with respect to carrying out purpose of
allotments
Section 7 revises the requirement of trauma care
modifications to the State plan to ensure that the plan
provides for access to the highest possible quality of trauma
care.
The section prohibits the Secretary from making trauma care
grants to a State unless the State's emergency medical services
plan coordinates planning for trauma systems with state
disaster emergency planning and bioterrorism hospital
preparedness planning.
The section directs the Secretary to update the model
trauma care plan to update policies that may be adopted by the
State.
Section 8. Requirement of submission to Secretary of trauma plan and
certain information
Section 8 prohibits the Secretary from making trauma care
grants to a State unless the State submits to the Secretary the
trauma care component of the State plan, including any changes
to the trauma care component together with any deficiencies, an
interim component, or description of effort toward the
completion of the component. States must evaluate the
availability of emergency medical services in rural areas.
The section directs the Secretary to update the model plan
for the designation of trauma centers and for triage, transfer,
and transportation policies.
Section 9. Restrictions on use of payments
Section 9 revises the restrictions on use of payments and
modifies the waiver authority of the Secretary over such
restrictions.
Section 10. Requirements of reports by States
Section 10 strikes section 1216, which requires annual
reports by States.
Section 11. Report by Secretary
Section 11 requires the Secretary to report to Congress on
Federal and State efforts to develop systems of trauma care no
later than October 1, 2008.
Section 12. Funding
Section 12 extends the authorization of appropriations for
parts A and B for five fiscal years through fiscal year 2012.
The section clarifies that the amount authorized to be
appropriated for carrying out part A (program and competitive
grant funding) and part B (State formula funding) is for the
purposes of carrying out each part, which may include
administrative and technical assistance. Clarifies that under
part A, 10 percent is allocated to each for administrative
purposes and 10 percent is allocated for the purpose of
carrying out rural trauma improvement under section 1202.
Section 13. Residency training programs in emergency medicine
Section 13 extends the authorization of appropriations for
section 1251 for five fiscal years through fiscal year 2012.
Section 14. State grants for certain projects
Section 14 amends the section heading of section 1252 so
that it reads ``State Grants for Projects Regarding 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 XII--TRAUMA CARE
Part A--General Authority and Duties of Secretary
[SEC. 1201. ESTABLISHMENT.
[(a) In General.--The Secretary shall, with respect to trauma
care--
[(1) conduct and support research, training,
evaluations, and demonstration projects;
[(2) foster the development of appropriate, modern
systems of such care through the sharing of information
among agencies and individuals involved in the study
and provision of such care;
[(3) provide to State and local agencies technical
assistance; and
[(4) sponsor workshops and conferences.
[(b) Grants, Cooperative Agreements, and Contracts.--The
Secretary may make grants, and enter into cooperative
agreements and contracts, for the purpose of carrying out
subsection (a).
[(c) Administration.--The Administrator of the Health
Resources and Services Administration shall ensure that this
title is administered by the Division of Trauma and Emergency
Medical Systems within such Administration. Such Division shall
be headed by a director appointed by the Secretary from among
individuals who are knowledgeable by training or experience in
the development and operation of trauma and emergency medical
systems.
[SEC. 1202. CLEARINGHOUSE ON TRAUMA CARE AND EMERGENCY MEDICAL
SERVICES.
[(a) Establishment.--The Secretary shall by contract provide
for the establishment and operation of a National Clearinghouse
on Trauma Care and Emergency Medical Services (hereafter in
this section referred to as the ``Clearinghouse'').
[(b) Duties.--The Clearinghouse shall--
[(1) foster the development of appropriate, modern
trauma care and emergency medical services (including
the development of policies for the notification of
family members of individuals involved in medical
emergencies) through the sharing of information among
agencies and individuals involved in planning,
furnishing, and studying such services and care;
[(2) collect, compile, and disseminate information on
the achievements of, and problems experienced by, State
and local agencies and private entities in providing
trauma care and emergency medical services and, in so
doing, give special consideration of the unique needs
of rural areas;
[(3) provide technical assistance relating to trauma
care and emergency medical services to State and local
agencies; and
[(4) sponsor workshops and conferences on trauma care
and emergency medical services.
[(c) Fees and Assessments.--A contract entered into by the
Secretary under this section may provide that the Clearinghouse
charge fees or assessments in order to defray, and beginning
with fiscal year 1992, to cover, the costs of operating the
Clearinghouse.
[SEC. 1203. ESTABLISHMENT OF PROGRAMS FOR IMPROVING TRAUMA CARE IN
RURAL AREAS.
[(a) In General.--The Secretary may make grants to public and
nonprofit private entities for the purpose of carrying out
research and demonstration projects with respect to improving
the availability and quality of emergency medical services in
rural areas--
[(1) by developing innovative uses of communications
technologies and the use of new communications
technology;
[(2) by developing model curricula for training
emergency medical services personnel, including first
responders, emergency medical technicians, emergency
nurses and physicians, and paramedics--
[(A) in the assessment, stabilization,
treatment, preparation for transport, and
resuscitation of seriously injured patients,
with special attention to problems that arise
during long transports and to methods of
minimizing delays in transport to the
appropriate facility; and
[(B) in the management of the operation of
the emergency medical services system;
[(3) by making training for original certification,
and continuing education, in the provision and
management of emergency medical services more
accessible to emergency medical personnel in rural
areas through telecommunications, home studies,
providing teachers and training at locations accessible
to such personnel, and other methods;
[(4) by developing innovative protocols and
agreements to increase access to prehospital care and
equipment necessary for the transportation of seriously
injured patients to the appropriate facilities; and
[(5) by evaluating the effectiveness of protocols
with respect to emergency medical services and systems.
[(b) Special Consideration for Certain Rural Areas.--In
making grants under subsection (a), the Secretary shall give
special consideration to any applicant for the grant that will
provide services under the grant in any rural area identified
by a State under section 1214(c)(1).
[(c) Requirement of Application.--The Secretary may not make
a grant under subsection (a) unless an application for the
grant is submitted to the Secretary and the application is in
such form, is made in such manner, and contains such
agreements, assurances, and information as the Secretary
determines to be necessary to carry out this section.]
SEC. 1201. ESTABLISHMENT.
(a) In General.--The Secretary shall, with respect to trauma
care--
(1) conduct and support research, training,
evaluations, and demonstration projects;
(2) foster the development of appropriate, modern
systems of such care through the sharing of information
among agencies and individuals involved in the study
and provision of such care;
(3) collect, compile, and disseminate information on
the achievements of, and problems experienced by, State
and local agencies and private entities in providing
trauma care and emergency medical services and, in so
doing, give special consideration to the unique needs
of rural areas;
(4) provide to State and local agencies technical
assistance to enhance each State's capability to
develop, implement, and sustain the trauma care
component of each State's plan for the provision of
emergency medical services;
(5) sponsor workshops and conferences; and
(6) promote the collection and categorization of
trauma data in a consistent and standardized manner.
(b) Grants, Cooperative Agreements, and Contracts.--The
Secretary may make grants, and enter into cooperative
agreements and contracts, for the purpose of carrying out
subsection (a).
SEC. 1202. ESTABLISHMENT OF PROGRAMS FOR IMPROVING TRAUMA CARE IN RURAL
AREAS.
(a) In General.--The Secretary may make grants to public and
nonprofit private entities for the purpose of carrying out
research and demonstration projects with respect to improving
the availability and quality of emergency medical services in
rural areas--
(1) by developing innovative uses of communications
technologies and the use of new communications
technology;
(2) by developing model curricula, such as advanced
trauma life support, for training emergency medical
services personnel, including first responders,
emergency medical technicians, emergency nurses and
physicians, and paramedics--
(A) in the assessment, stabilization,
treatment, preparation for transport, and
resuscitation of seriously injured patients,
with special attention to problems that arise
during long transports and to methods of
minimizing delays in transport to the
appropriate facility; and
(B) in the management of the operation of the
emergency medical services system;
(3) by making training for original certification,
and continuing education, in the provision and
management of emergency medical services more
accessible to emergency medical personnel in rural
areas through telecommunications, home studies,
providing teachers and training at locations accessible
to such personnel, and other methods;
(4) by developing innovative protocols and agreements
to increase access to prehospital care and equipment
necessary for the transportation of seriously injured
patients to the appropriate facilities;
(5) by evaluating the effectiveness of protocols with
respect to emergency medical services and systems; and
(6) by increasing communication and coordination with
State trauma systems.
(b) Special Consideration for Certain Rural Areas.--In making
grants under subsection (a), the Secretary shall give special
consideration to any applicant for the grant that will provide
services under the grant in any rural area identified by a
State under section 1214(d)(1).
(c) Requirement of Application.--The Secretary may not make a
grant under subsection (a) unless an application for the grant
is submitted to the Secretary and the application is in such
form, is made in such manner, and contains such agreements,
assurances, and information as the Secretary determines to be
necessary to carry out this section.
SEC. 1203. COMPETITIVE GRANTS FOR THE IMPROVEMENT OF TRAUMA CARE.
(a) In General.--The Secretary, acting through the
Administrator of the Health Resources and Services
Administration, may make grants to States, political
subdivisions, or consortia of States or political subdivisions
for the purpose of improving access to and enhancing the
development of trauma care systems.
(b) Use of Funds.--The Secretary may make a grant under this
section only if the applicant agrees to use the grant--
(1) to integrate and broaden the reach of a trauma
care system, such as by developing innovative protocols
to increase access to prehospital care;
(2) to strengthen, develop, and improve an existing
trauma care system;
(3) to expand communications between the trauma care
system and emergency medical services through improved
equipment or a telemedicine system;
(4) to improve data collection and retention; or
(5) to increase education, training, and technical
assistance opportunities, such as training and
continuing education in the management of emergency
medical services accessible to emergency medical
personnel in rural areas through telehealth, home
studies, and other methods.
(c) Preference.--In selecting among States, political
subdivisions, and consortia of States or political subdivisions
for purposes of making grants under this section, the Secretary
shall give preference to applicants that--
(1) have developed a process, using national
standards, for designating trauma centers;
(2) recognize protocols for the delivery of seriously
injured patients to trauma centers;
(3) implement a process for evaluating the
performance of the trauma system; and
(4) agree to participate in information systems
described in section 1202 by collecting, providing, and
sharing information.
(d) Priority.--In making grants under this section, the
Secretary shall give priority to applicants that will use the
grants to focus on improving access to trauma care systems.
(e) Special Consideration.--In awarding grants under this
section, the Secretary shall give special consideration to
projects that demonstrate strong State or local support,
including availability of non-Federal contributions.
Part B--Formula Grants With Respect to Modifications of State Plans
* * * * * * *
[SEC. 1212 REQUIREMENT OF MATCHING FUNDS FOR FISCAL YEARS SUBSEQUENT TO
FIRST FISCAL YEAR OF PAYMENTS.
[(a) Non-Federal Contributions.--
[(1) In general.--The Secretary may not make payments
under section 1211(a) unless the State involved agrees,
with respect to the costs described in paragraph (2),
to make available non-Federal contributions (in cash or
in kind under subsection (b)(1)) toward such costs in
an amount equal to--
[(A) for the second fiscal year of such
payments to the State, not less than $1 for
each $1 of Federal funds provided in such
payments for such fiscal year; and
[(B) for any subsequent fiscal year of such
payments to the State, not less than $3 for
each $1 of Federal funds provided in such
payments for such fiscal year.
[(2) Program costs.--The costs referred to in
paragraph (1) are--
[(A) the costs to be incurred by the State in
carrying out the purpose described in section
1211(b); or
[(B) the costs of improving the quality and
availability of emergency medical services in
rural areas of the State.
[(3) Initial year of payments.--The Secretary may not
require a State to make non-Federal contributions as a
condition of receiving payments under section 1211(a)
for the first fiscal year of such payments to the
State.
[(b) Determination of Amount of Non-Federal Contribution.--
With respect to compliance with subsection (a) as a condition
of receiving payments under section 1211(a)--
[(1) a State may make the non-Federal contributions
required in such subsection in cash or in kind, fairly
evaluated, including plant, equipment, or services;
[(2) the Secretary may not, in making a determination
of the amount of non-Federal contributions, include
amounts provided by the Federal Government or services
assisted or subsidized to any significant extent by the
Federal Government; and
[(3) the Secretary shall, in making such a
determination, include only non-Federal contributions
in excess of the amount of non-Federal contributions
made by the State during fiscal year 1990 toward--
[(A) the costs of providing trauma care in
the State; and
[(B) the costs of improving the quality and
availability of emergency medical services in
rural areas of the State.
[SEC. 1213. REQUIREMENTS WITH RESPECT TO CARRYING OUT PURPOSE OF
ALLOTMENTS.
[(a) Trauma Care Modifications to State Plan for Emergency
Medical Services.--With respect to the trauma care component of
a State plan for the provision of emergency medical services,
the modifications referred to in section 1211(b) are such
modifications to the State plan as may be necessary for the
State involved to ensure that the plan provides for access to
the highest possible quality of trauma care, and that the
plan--
[(1) specifies that the modifications required
pursuant to paragraphs (2) through (10) will be
implemented by the principal State agency with respect
to emergency medical services or by the designee of
such agency;
[(2) specifies any public or private entity that will
designate trauma care regions and trauma centers in the
State;
[(3) subject to subsection (b), contains standards
and requirements for the designation of level I and
level II trauma centers, and in the case of rural areas
level III trauma centers (including trauma centers with
specified capabilities and expertise in the care of the
pediatric trauma patient), by such entity, including
standards and requirements for--
[(A) the number and types of trauma patients
for whom such centers must provide care in
order to ensure that such centers will have
sufficient experience and expertise to be able
to provide quality care for victims of injury;
[(B) the resources and equipment needed by
such centers; and
[(C) the availability of rehabilitation
services for trauma patients;
[(4) subject to subsection (b), contains standards
and requirements for the implementation of regional
trauma care systems, including standards and guidelines
(consistent with the provisions of section 1867 of the
Social Security Act) for medically directed triage and
transportation of trauma patients (including patients
injured in rural areas) prior to care in designated
trauma centers;
[(5) subject to subsection (b), contains standards
and requirements for medically directed triage and
transport of severely injured children to designated
trauma centers with specified capabilities and
expertise in the care of the pediatric trauma patient;
[(6) specifies procedures for the evaluation of
designated trauma centers (including trauma centers
described in paragraph (5)) and trauma care systems;
[(7) provides for the establishment and collection of
data from each designated trauma center in the State of
a central data reporting and analysis system--
[(A) to identify the number of severely
injured trauma patients within regional trauma
care systems in the State;
[(B) to identify the cause of the injury and
any factors contributing to the injury;
[(C) to identify the nature and severity of
the injury;
[(D) to monitor trauma patient care
(including prehospital care) in each designated
trauma center within regional trauma care
systems in the State (including relevant
emergency-department discharges and
rehabilitation information) for the purpose of
evaluating the diagnosis, treatment and
treatment outcome of such trauma patients;
[(E) to identify the total amount of
uncompensated trauma care expenditures for each
fiscal year by each designated trauma center in
the State; and
[(F) to identify patients transferred within
a regional trauma system, including reasons for
such transfer;
[(8) provides for the use of procedures by paramedics
and emergency medical technicians to assess the
severity of the injuries incurred by trauma patients;
[(9) provides for appropriate transportation and
transfer policies to ensure the delivery of patients to
designated trauma centers and other facilities within
and outside of the jurisdiction of such system,
including policies to ensure that only individuals
appropriately identified as trauma patients are
transferred to designated trauma centers, and to
provide periodic reviews of the transfers and the
auditing of such transfers that are determined to be
appropriate;
[(10) conducts public education activities concerning
injury prevention and obtaining access to trauma care;
and
[(11) with respect to the requirements established in
this subsection, provides for coordination and
cooperation between the State and any other State with
which the State shares any standard metropolitan
statistical area.
[(b) Certain Standards With Respect to Trauma Care Centers
and Systems.--
[(1) In general.--The Secretary may not make payments
under section 1211(a) for a fiscal year unless the
State involved agrees that, in carrying out paragraphs
(3) through (5) of subsection (a), the State will adopt
standards for the designation of trauma centers, and
for triage, transfer, and transportation policies, and
that the State will, in adopting such standards--
[(A) take into account national standards
concerning such;
[(B) consult with medical, surgical, and
nursing speciality groups, hospital
associations, emergency medical services State
and local directors, concerned advocates and
other interested parties;
[(C) conduct hearings on the proposed
standards after providing adequate notice to
the public concerning such hearing; and
[(D) beginning in fiscal year 1992, take into
account the model plan described in subsection
(c).
[(2) Quality of trauma care.--The highest quality of
trauma care shall be the primary goal of State
standards adopted under this subsection.
[(3) Approval by secretary.--The Secretary may not
make payments under section 1211(a) to a State if the
Secretary determines that--
[(A) in the case of payments for fiscal year
1991 and subsequent fiscal years, the State has
not taken into account national standards,
including those of the American College of
Surgeons, the American College of Emergency
Physicians and the American Academy of
Pediatrics, in adopting standards under this
subsection; or
[(B) in the case of payments for fiscal year
1992 and subsequent fiscal years, the State has
not, in adopting such standards, taken into
account the model plan developed under
subsection (c) .
[(c) Model Trauma Care Plan.--Not later than 1 year after the
date of the enactment of the Trauma Care Systems Planning and
Development Act of 1990, the Secretary shall develop a model
plan for the designation of trauma centers and for triage,
transfer and transportation policies that may be adopted for
guidance by the State. Such plan shall--
[(1) take into account national standards, including
those of the American College of Surgeons, American
College of Emergency Physicians and the American
Academy of Pediatrics;
[(2) take into account existing State plans;
[(3) be developed in consultation with medical,
surgical, and nursing speciality groups, hospital
associations, emergency medical services State
directors and associations, and other interested
parties; and
[(4) include standards for the designation of rural
health facilities and hospitals best able to receive,
stabilize, and transfer trauma patients to the nearest
appropriate designated trauma center, and for triage,
transfer, and transportation policies as they relate to
rural areas.
Standards described in paragraph (4) shall be applicable to all
rural areas in the State, including both non-metropolitan areas
and frontier areas that have populations of less than 6,000 per
square mile.
[(d) Rule of Construction With Respect to Number of
Designated Trauma Centers.--With respect to compliance with
subsection (a) as a condition of the receipt of a grant under
section 1211(a), such subsection may not be construed to
specify the number of trauma care centers designated pursuant
to such subsection.
[SEC. 1214. REQUIREMENT OF SUBMISSION TO SECRETARY OF TRAUMA PLAN AND
CERTAIN INFORMATION.
[(a) Trauma Plan.--
[(1) In general.--For fiscal year 1991 and subsequent
fiscal years, the Secretary may not make payments under
section 1211(a) unless, subject to paragraph (2), the
State involved submits to the Secretary the trauma care
component of the State plan for the provision of
emergency medical services.
[(2) Interim plan or description of efforts.--For
fiscal year 1991, if a State has not completed the
trauma care component of the State plan described in
paragraph (1), the State may provide, in lieu of a
completed such component, an interim component or a
description of efforts made toward the completion of
the component.
[(b) Information Received by State Reporting and Analysis
System.--The Secretary may not make payments under section
1211(a) for a fiscal year unless the State involved agrees that
the State will, not less than once each year, provide to the
Secretary the information received by the State pursuant to
section 1213(a)(7).
[(c) Availability of Emergency Medical Services in Rural
Areas.--The Secretary may not make payments under section
1211(a) for a fiscal year unless--
[(1) the State involved identifies any rural area in
the State for which--
[(A) there is no system of access to
emergency medical services through the
telephone number 911;
[(B) there is no basic life-support system;
or
[(C) there is no advanced life-support
system; and
[(2) the State submits to the Secretary a list of
rural areas identified pursuant to paragraph (1) or, if
there are no such areas, a statement that there are no
such areas.
[SEC. 1215. RESTRICTIONS ON USE OF PAYMENTS.
[(a) In General.--The Secretary may not, except as provided
in subsection (b), make payments under section 1211(a) for a
fiscal year unless the State involved agrees that the payments
will not be expended--
[(1) subject to section 1233, for any purpose other
than developing, implementing, and monitoring the
modifications required by section 1211(b) to be made to
the State plan for the provision of emergency medical
services.
[(2) to make cash payments to intended recipients of
services provided pursuant to such section;
[(3) to purchase or improve real property (other than
minor remodeling of existing improvements to real
property) or to purchase major medical or communication
equipment, ambulances, or aircraft;
[(4) to satisfy any requirement for the expenditure
of non-Federal funds as a condition for the receipt of
Federal funds; or
[(5) to provide financial assistance to any entity
other than a public or nonprofit private entity.
[(b) Exception.--If the Secretary finds that the purpose
described in section 1211(b) cannot otherwise be carried out,
the Secretary may, with respect to an otherwise qualified
State, waive the restriction established in subsection (a)(3).
[SEC. 1216. REQUIREMENT OF REPORTS BY STATES.
[(a) In General.--The Secretary may not make payments under
section 1211(a) for a fiscal year unless the State involved
agrees to prepare and submit to the Secretary an annual report
in such form and containing such information as the Secretary
determines (after consultation with the States) to be necessary
for--
[(1) securing a record and a description of the
purposes for which payments received by the State
pursuant to such section were expended and of the
recipients of such payments; and
[(2) determining whether the payments were expended
in accordance with the purpose of the program involved.
[(b) Availability to Public of Reports.--The Secretary may
not make payments under section 1211(a) unless the State
involved agrees that the State will make copies of the report
described in subsection (a) available for public inspection.
[(c) Evaluations by Comptroller General.--The Comptroller
General of the United States shall evaluate the expenditures by
States of payments under section 1211(a) in order to assure
that expenditures are consistent with the provisions of this
part, and not later than December 1, 1994, prepare and submit
to the Committee on Energy and Commerce of the House of
Representatives and the Committee on Labor and Human Resources
of the Senate a report concerning such evaluation.]
SEC. 1212. REQUIREMENT OF MATCHING FUNDS FOR FISCAL YEARS SUBSEQUENT TO
FIRST FISCAL YEAR OF PAYMENTS.
(a) Non-Federal Contributions.--
(1) In general.--The Secretary may not make payments
under section 1211(a) unless the State involved agrees,
with respect to the costs described in paragraph (2),
to make available non-Federal contributions (in cash or
in kind under subsection (b)(1)) toward such costs in
an amount that--
(A) for the second and third fiscal years of
such payments to the State, is not less than $1
for each $1 of Federal funds provided in such
payments for such fiscal years; and
(B) for the fourth and subsequent fiscal
years of such payments to the State, is not
less than $2 for each $1 of Federal funds
provided in such payments for such fiscal
years.
(2) Program costs.--The costs referred to in
paragraph (1) are--
(A) the costs to be incurred by the State in
carrying out the purpose described in section
1211(b); or
(B) the costs of improving the quality and
availability of emergency medical services in
rural areas of the State.
(3) Initial year of payments.--The Secretary may not
require a State to make non-Federal contributions as a
condition of receiving payments under section 1211(a)
for the first fiscal year of such payments to the
State.
(b) Determination of Amount of Non-Federal Contribution.--
With respect to compliance with subsection (a) as a condition
of receiving payments under section 1211(a)--
(1) a State may make the non-Federal contributions
required in such subsection in cash or in kind, fairly
evaluated, including plant, equipment, or services; and
(2) the Secretary may not, in making a determination
of the amount of non-Federal contributions, include
amounts provided by the Federal Government or services
assisted or subsidized to any significant extent by the
Federal Government.
SEC. 1213. REQUIREMENTS WITH RESPECT TO CARRYING OUT PURPOSE OF
ALLOTMENTS.
(a) Trauma Care Modifications to State Plan for Emergency
Medical Services.--With respect to the trauma care component of
a State plan for the provision of emergency medical services,
the modifications referred to in section 1211(b) are such
modifications to the State plan as may be necessary for the
State involved to ensure that the plan provides for access to
the highest possible quality of trauma care, and that the
plan--
(1) specifies that the modifications required
pursuant to paragraphs (2) through (11) will be
implemented by the principal State agency with respect
to emergency medical services or by the designee of
such agency;
(2) specifies a public or private entity that will
designate trauma care regions and trauma centers in the
State;
(3) subject to subsection (b), contains national
standards and requirements of the American College of
Surgeons or another appropriate entity for the
designation of level I and level II trauma centers, and
in the case of rural areas level III trauma centers
(including trauma centers with specified capabilities
and expertise in the care of pediatric trauma
patients), by such entity, including standards and
requirements for--
(A) the number and types of trauma patients
for whom such centers must provide care in
order to ensure that such centers will have
sufficient experience and expertise to be able
to provide quality care for victims of injury;
(B) the resources and equipment needed by
such centers; and
(C) the availability of rehabilitation
services for trauma patients;
(4) contains standards and requirements for the
implementation of regional trauma care systems,
including standards and guidelines (consistent with the
provisions of section 1867 of the Social Security Act)
for medically directed triage and transportation of
trauma patients (including patients injured in rural
areas) prior to care in designated trauma centers;
(5) subject to subsection (b), contains national
standards and requirements, including those of the
American Academy of Pediatrics and the American College
of Emergency Physicians, for medically directed triage
and transport of severely injured children to
designated trauma centers with specified capabilities
and expertise in the care of pediatric trauma patients;
(6) utilizes a program with procedures for the
evaluation of designated trauma centers (including
trauma centers described in paragraph (5)) and trauma
care systems;
(7) provides for the establishment and collection of
data in accordance with data collection requirements
developed in consultation with surgical, medical, and
nursing specialty groups, State and local emergency
medical services directors, and other trained
professionals in trauma care, from each designated
trauma center in the State of a central data reporting
and analysis system--
(A) to identify the number of severely
injured trauma patients and the number of
deaths from trauma within trauma care systems
in the State;
(B) to identify the cause of the injury and
any factors contributing to the injury;
(C) to identify the nature and severity of
the injury;
(D) to monitor trauma patient care (including
prehospital care) in each designated trauma
center within regional trauma care systems in
the State (including relevant emergency-
department discharges and rehabilitation
information) for the purpose of evaluating the
diagnosis, treatment, and treatment outcome of
such trauma patients;
(E) to identify the total amount of
uncompensated trauma care expenditures for each
fiscal year by each designated trauma center in
the State; and
(F) to identify patients transferred within a
regional trauma system, including reasons for
such transfer and the outcomes of such
patients;
(8) provides for the use of procedures by paramedics
and emergency medical technicians to assess the
severity of the injuries incurred by trauma patients;
(9) provides for appropriate transportation and
transfer policies to ensure the delivery of patients to
designated trauma centers and other facilities within
and outside of the jurisdiction of such system,
including policies to ensure that only individuals
appropriately identified as trauma patients are
transferred to designated trauma centers, and to
provide periodic reviews of the transfers and the
auditing of such transfers that are determined to be
appropriate;
(10) conducts public education activities concerning
injury prevention and obtaining access to trauma care;
(11) coordinates planning for trauma systems with
State disaster emergency planning and bioterrorism
hospital preparedness planning; and
(12) with respect to the requirements established in
this subsection, provides for coordination and
cooperation between the State and any other State with
which the State shares any standard metropolitan
statistical area.
(b) Certain Standards With Respect to Trauma Care Centers and
Systems.--
(1) In general.--The Secretary may not make payments
under section 1211(a) for a fiscal year unless the
State involved agrees that, in carrying out paragraphs
(3) through (5) of subsection (a), the State will adopt
standards for the designation of trauma centers, and
for triage, transfer, and transportation policies, and
that the State will, in adopting such standards--
(A) take into account national standards that
outline resources for optimal care of injured
patients;
(B) consult with medical, surgical, and
nursing speciality groups, hospital
associations, emergency medical services State
and local directors, concerned advocates, and
other interested parties;
(C) conduct hearings on the proposed
standards after providing adequate notice to
the public concerning such hearing; and
(D) beginning in fiscal year 2008, take into
account the model plan described in subsection
(c).
(2) Quality of trauma care.--The highest quality of
trauma care shall be the primary goal of State
standards adopted under this subsection.
(3) Approval by the secretary.--The Secretary may not
make payments under section 1211(a) to a State if the
Secretary determines that--
(A) in the case of payments for fiscal year
2008 and subsequent fiscal years, the State has
not taken into account national standards,
including those of the American College of
Surgeons, the American College of Emergency
Physicians, and the American Academy of
Pediatrics, in adopting standards under this
subsection; or
(B) in the case of payments for fiscal year
2008 and subsequent fiscal years, the State has
not, in adopting such standards, taken into
account the model plan developed under
subsection (c).
(c) Model Trauma Care Plan.--
(1) In general.--Not later than 1 year after the date
of the enactment of the Trauma Care Systems Planning
and Development Act of 2007, the Secretary shall update
the model plan for the designation of trauma centers
and for triage, transfer, and transportation policies
that may be adopted for guidance by the State. Such
plan shall--
(A) take into account national standards,
including those of the American College of
Surgeons, American College of Emergency
Physicians, and the American Academy of
Pediatrics;
(B) take into account existing State plans;
(C) be developed in consultation with
medical, surgical, and nursing speciality
groups, hospital associations, emergency
medical services State directors and
associations, and other interested parties; and
(D) include standards for the designation of
rural health facilities and hospitals best able
to receive, stabilize, and transfer trauma
patients to the nearest appropriate designated
trauma center, and for triage, transfer, and
transportation policies as they relate to rural
areas.
(2) Applicability.--Standards described in paragraph
(1)(D) shall be applicable to all rural areas in the
State, including both non-metropolitan areas and
frontier areas that have populations of less than 6,000
per square mile.
(d) Rule of Construction With Respect to Number of Designated
Trauma Centers.--With respect to compliance with subsection (a)
as a condition of the receipt of a grant under section 1211(a),
such subsection may not be construed to specify the number of
trauma care centers designated pursuant to such subsection.
SEC. 1214. REQUIREMENT OF SUBMISSION TO SECRETARY OF TRAUMA PLAN AND
CERTAIN INFORMATION.
(a) In General.--For each fiscal year, the Secretary may not
make payments to a State under section 1211(a) unless, subject
to subsection (b), the State submits to the Secretary the
trauma care component of the State plan for the provision of
emergency medical services, including any changes to the trauma
care component and any plans to address deficiencies in the
trauma care component.
(b) Interim Plan or Description of Efforts.--For each fiscal
year, if a State has not completed the trauma care component of
the State plan described in subsection (a), the State may
provide, in lieu of such completed component, an interim
component or a description of efforts made toward the
completion of the component.
(c) Information Received by State Reporting and Analysis
System.--The Secretary may not make payments to a State under
section 1211(a) unless the State agrees that the State will,
not less than once each year, provide to the Secretary the
information received by the State pursuant to section
1213(a)(7).
(d) Availability of Emergency Medical Services in Rural
Areas.--The Secretary may not make payments to a State under
section 1211(a) unless--
(1) the State identifies any rural area in the State
for which--
(A) there is no system of access to emergency
medical services through the telephone number
911;
(B) there is no basic life-support system; or
(C) there is no advanced life-support system;
and
(2) the State submits to the Secretary a list of
rural areas identified pursuant to paragraph (1) or, if
there are no such areas, a statement that there are no
such areas.
SEC. 1215. RESTRICTIONS ON USE OF PAYMENTS.
(a) In General.--The Secretary may not, except as provided in
subsection (b), make payments under section 1211(a) for a
fiscal year unless the State involved agrees that the payments
will not be expended--
(1) for any purpose other than developing,
implementing, and monitoring the modifications required
by section 1211(b) to be made to the State plan for the
provision of emergency medical services;
(2) to make cash payments to intended recipients of
services provided pursuant to this section;
(3) to purchase or improve real property (other than
minor remodeling of existing improvements to real
property);
(4) to satisfy any requirement for the expenditure of
non-Federal funds as a condition for the receipt of
Federal funds; or
(5) to provide financial assistance to any entity
other than a public or nonprofit private entity.
(b) Waiver.--The Secretary may waive a restriction under
subsection (a) only if the Secretary determines that the
activities outlined by the State plan submitted under section
1214(a) by the State involved cannot otherwise be carried out.
* * * * * * *
[SEC. 1222. REPORT BY SECRETARY.
[Not later than October 1, 1995, the Secretary shall report
to the appropriate committees of Congress on the activities of
the States carried out pursuant to section 1211. Such report
shall include an assessment of the extent to which Federal and
State efforts to develop systems of trauma care and to
designate trauma centers have reduced the incidence of
mortality, and the incidence of permanent disability, resulting
from trauma. Such report may include any recommendations of the
Secretary for appropriate administrative and legislative
initiatives with respect to trauma care.]
SEC. 1222. REPORT BY SECRETARY.
Not later than October 1, 2008, the Secretary shall report to
the appropriate committees of Congress on the activities of the
States carried out pursuant to section 1211. Such report shall
include an assessment of the extent to which Federal and State
efforts to develop systems of trauma care and to designate
trauma centers have reduced the incidence of mortality, and the
incidence of permanent disability, resulting from trauma. Such
report may include any recommendations of the Secretary for
appropriate administrative and legislative initiatives with
respect to trauma care.
* * * * * * *
Part C--General Provisions Regarding Parts A and B
* * * * * * *
[SEC. 1232. FUNDING.
[(a) Authorization of Appropriations.--For the purpose of
carrying out parts A and B, there are authorized to be
appropriated $6,000,000 for fiscal year 1994, and such sums as
may be necessary for each of the fiscal years 1995 through
2002.
[(b) Allocation of Funds by Secretary.--
[(1) General authority.--For the purpose of carrying
out part A, the Secretary shall make available 10
percent of the amounts appropriated for a fiscal year
under subsection (a).
[(2) Rural grants.--For the purpose of carrying out
section 1204, the Secretary shall make available 10
percent of the amounts appropriated for a fiscal year
under subsection (a).
[(3) Formula grants.--
[(A) For the purpose of making allotments
under section 1211(a), the Secretary shall,
subject to subsection (c), make available 80
percent of the amounts appropriated for a
fiscal year pursuant to subsection (a).
[(B) Amounts paid to a State under section
1211(a) for a fiscal year shall, for the
purposes for which the amounts were paid,
remain available for obligation until the end
of the fiscal year immediately following the
fiscal year for which the amounts were paid.
[(c) Effect of Insufficient Appropriations for Minimum
Allotments.--
[(1) In general.--If the amounts made available under
subsection (b)(3)(A) for a fiscal year are insufficient
for providing each State with an allotment under
section 1211(a) of not less than the applicable amount
under section 1218(a)(2), the Secretary shall, from
such amounts as are made available under subsection
(b)(3)(A), make grants to States described in paragraph
(2) for carrying out part B.
[(2) Eligible states.--The States referred to in
paragraph (1) are States that--
[(A) have the greatest need to develop,
implement, and maintain trauma care systems;
and
[(B) demonstrate in their applications under
section 1217 the greatest commitment to
establishing and maintaining such systems.
[(3) Rule of construction.--Paragraph (1) may not be
construed to require the Secretary to make a grant
under such paragraph to each State.]
SEC. 1232. FUNDING.
(a) Authorization of Appropriations.--For the purpose of
carrying out parts A and B, subject to subsections (b) and (c),
there are authorized to be appropriated $12,000,000 for fiscal
year 2008, $10,000,000 for fiscal year 2009, and $8,000,000 for
each of the fiscal years 2010 through 2012.
(b) Reservation of Funds.--If the amount appropriated under
subsection (a) for a fiscal year is equal to or less than
$1,000,000, such appropriation is available only for the
purpose of carrying out part A. If the amount so appropriated
is greater than $1,000,000, 50 percent of such appropriation
shall be made available for the purpose of carrying out part A
and 50 percent shall be made available for the purpose of
carrying out part B.
(c) Allocation of Part A Funds.--Of the amounts appropriated
under subsection (a) for a fiscal year to carry out part A--
(1) 10 percent of such amounts for such year shall be
allocated for administrative purposes; and
(2) 10 percent of such amounts for such year shall be
allocated for the purpose of carrying out section 1202.
* * * * * * *
Part E--Miscellaneous Programs
[SEC. 1251. RESIDENCY TRAINING PROGRAMS IN EMERGENCY MEDICINE.
[(a) In General.--The Secretary may make grants to public and
nonprofit private entities for the purpose of planning and
developing approved residency training programs in emergency
medicine.
[(b) Identification and Referral of Domestic Violence.--The
Secretary may make a grant under subsection (a) only if the
applicant involved agrees that training programs under
subsection (a) will provide education and training in
identifying and referring cases of domestic violence.
[(c) Authorization of Appropriations.--For the purpose of
carrying out this section, there is authorized to be
appropriated $400,000 for each of the fiscal years 1993 through
1995.]
SEC. 1251. RESIDENCY TRAINING PROGRAMS IN EMERGENCY MEDICINE.
(a) In General.--The Secretary may make grants to public and
nonprofit private entities for the purpose of planning and
developing approved residency training programs in emergency
medicine.
(b) Identification and Referral of Domestic Violence.--The
Secretary may make a grant under subsection (a) only if the
applicant involved agrees that the training programs under
subsection (a) will provide education and training in
identifying and referring cases of domestic violence.
(c) Authorization of Appropriations.--For the purpose of
carrying out this section, there is authorized to be
appropriated $400,000 for each of the fiscal years 2008 though
2012.
SEC. 1252. STATE GRANTS FOR [DEMONSTRATION] PROJECTS REGARDING
TRAUMATIC BRAIN INJURY.
(a) * * *
* * * * * * *
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