[Congressional Bills 107th Congress]
[From the U.S. Government Publishing Office]
[S. 1274 Referred in House (RFH)]

  2d Session
                                S. 1274


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                            February 7, 2002

            Referred to the Committee on Energy and Commerce

_______________________________________________________________________

                                 AN ACT


 
  To amend the Public Health Service Act to provide programs for the 
          prevention, treatment, and rehabilitation of stroke.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Stroke Treatment and Ongoing 
Prevention Act of 2002''.

SEC. 2. FINDINGS AND GOAL.

    (a) Findings.--Congress makes the following findings:
            (1) Stroke is the third leading cause of death in the 
        United States. Each year over 750,000 Americans suffer a new or 
        recurrent stroke and 160,000 Americans die from stroke.
            (2) Stroke costs the United States $28,000,000,000 in 
        direct costs and $17,400,000,000 in indirect costs, each year.
            (3) Stroke is one of the leading causes of adult disability 
        in the United States. Between 15 percent and 30 percent of 
        stroke survivors are permanently disabled. Presently, there are 
        4,400,000 stroke survivors living in the United States.
            (4) Members of the general public have difficulty 
        recognizing the symptoms of stroke and are unaware that stroke 
        is a medical emergency. Fifty-eight percent of all stroke 
        patients wait 24 hours or more before presenting at the 
        emergency room. Forty-two percent of individuals over the age 
        of 50 do not recognize numbness or paralysis in the face, arm, 
        or leg as a sign of stroke and 17 percent of them cannot name a 
        single stroke symptom.
            (5) Recent advances in stroke treatment can significantly 
        improve the outcome for stroke patients, but these therapies 
        must be administered properly and promptly. Only 3 percent of 
        stroke patients who are candidates for acute stroke intravenous 
        thrombolytic drug therapy receive the appropriate medication.
            (6) New technologies, therapies, and diagnostic approaches 
        are currently being developed that will extend the therapeutic 
        timeframe and result in greater treatment efficacy for stroke 
        patients.
            (7) Few States and communities have developed and 
        implemented stroke awareness programs, prevention programs, or 
        comprehensive stroke care systems.
            (8) The degree of disability resulting from stroke can be 
        reduced substantially by educating the general public about 
        stroke and by improving the systems for the provision of stroke 
        care in the United States.
    (b) Goal.--It is the goal of this Act to improve the provision of 
stroke care in every State and territory and in the District of 
Columbia, and to increase public awareness about the prevention, 
detection, and treatment of stroke.

SEC. 3. SYSTEMS FOR STROKE PREVENTION, TREATMENT, AND REHABILITATION.

    The Public Health Service Act (42 U.S.C. 201 et seq.) is amended by 
adding at the end the following:

     ``TITLE XXVIII--SYSTEMS FOR STROKE PREVENTION, TREATMENT, AND 
                             REHABILITATION

           ``Part A--Stroke Prevention and Education Campaign

``SEC. 2801. STROKE PREVENTION AND EDUCATION CAMPAIGN.

    ``(a) In General.--The Secretary shall carry out a national 
education and information campaign to promote stroke prevention and 
increase the number of stroke patients who seek immediate treatment. In 
implementing such education and information campaign, the Secretary 
shall avoid duplicating existing stroke education efforts by other 
Federal Government agencies and may consult with national and local 
associations that are dedicated to increasing the public awareness of 
stroke, consumers of stroke awareness products, and providers of stroke 
care.
    ``(b) Use of Funds.--The Secretary may use amounts appropriated to 
carry out the campaign described in subsection (a)--
            ``(1) to make public service announcements about the 
        warning signs of stroke and the importance of treating stroke 
        as a medical emergency;
            ``(2) to provide education regarding ways to prevent stroke 
        and the effectiveness of stroke treatment;
            ``(3) to purchase media time and space;
            ``(4) to pay for out-of-pocket advertising production 
        costs;
            ``(5) to test and evaluate advertising and educational 
        materials for effectiveness, especially among groups at high 
        risk for stroke, including women, older adults, and African-
        Americans;
            ``(6) to develop alternative campaigns that are targeted to 
        unique communities, including rural and urban communities, and 
        communities in the `Stroke Belt';
            ``(7) to measure public awareness prior to the start of the 
        campaign on a national level and in targeted communities to 
        provide baseline data that will be used to evaluate the 
        effectiveness of the public awareness efforts; and
            ``(8) to carry out other activities that the Secretary 
        determines will promote prevention practices among the general 
        public and increase the number of stroke patients who seek 
        immediate care.
    ``(c) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out subsection (b), $40,000,000 for fiscal year 
2002, and such sums as may be necessary for each of fiscal years 2003 
through 2006.

       ``Part B--General Authorities and Duties of the Secretary

``SEC. 2811. ESTABLISHMENT.

    ``(a) In General.--The Secretary shall, with respect to stroke 
care--
            ``(1) make available, support, and evaluate a grant program 
        to enable a State to develop statewide stroke care systems;
            ``(2) foster the development of appropriate, modern systems 
        of stroke care through the sharing of information among 
        agencies and individuals involved in the study and provision of 
        such care; and
            ``(3) provide to State and local agencies technical 
        assistance.
    ``(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. 2812. PAUL COVERDELL NATIONAL ACUTE STROKE REGISTRY AND 
              CLEARINGHOUSE.

    ``(a) In General.--The Secretary shall maintain the Paul Coverdell 
National Acute Stroke Registry and Clearinghouse by--
            ``(1) continuing to develop and collect specific data 
        points as well as appropriate benchmarks for analyzing care of 
        acute stroke patients;
            ``(2) continuing to design and pilot test prototypes that 
        will measure the delivery of care to patients with acute stroke 
        in order to provide real-time data and analysis to reduce death 
        and disability from stroke and improve the quality of life for 
        acute stroke survivors;
            ``(3) fostering the development of effective, modern stroke 
        care systems (including the development of policies related to 
        emergency services systems) through the sharing of information 
        among agencies and individuals involved in planning, 
        furnishing, and studying such systems;
            ``(4) collecting, compiling, and disseminating information 
        on the achievements of, and problems experienced by, State and 
        local agencies and private entities in developing and 
        implementing stroke care systems and, in carrying out this 
        paragraph, giving special consideration to the unique needs of 
        rural facilities and those facilities with inadequate resources 
        for providing quality prevention, acute treatment, post-acute 
        treatment, and rehabilitation services for stroke patients;
            ``(5) providing technical assistance relating to stroke 
        care systems to State and local agencies; and
            ``(6) carrying out any other activities the Secretary 
        determines to be useful to fulfill the purposes of the Paul 
        Coverdell National Acute Stroke Registry and Clearinghouse.
    ``(b) Research on Stroke.--The Secretary shall, not earlier than 1 
year after the date of enactment of the Stroke Treatment and Ongoing 
Prevention Act of 2002, ensure the availability of published research 
on stroke or, where necessary, conduct research concerning--
            ``(1) best practices in the prevention, diagnosis, 
        treatment, and rehabilitation of stroke;
            ``(2) barriers to access to currently approved stroke 
        prevention, treatment, and rehabilitation services;
            ``(3) barriers to access to newly developed diagnostic 
        approaches, technologies, and therapies for stroke patients;
            ``(4) the effectiveness of existing public awareness 
        campaigns regarding stroke; and
            ``(5) disparities in the prevention, diagnosis, treatment, 
        and rehabilitation of stroke among different populations.
    ``(c) Certain Research Activities.--In carrying out the activities 
described in subsection (b), the Secretary may conduct--
            ``(1) studies with respect to all phases of stroke care, 
        including prehospital, acute, post-acute and rehabilitation 
        care;
            ``(2) studies with respect to patient access to currently 
        approved and newly developed stroke prevention and treatment 
        services, including a review of the effect of coverage, coding, 
        and reimbursement practices on access;
            ``(3) studies with respect to the effect of existing public 
        awareness campaigns on stroke; and
            ``(4) any other studies that the Secretary determines are 
        necessary or useful to conduct a thorough and effective 
        research program regarding stroke.
    ``(d) Mechanisms of Support.--In carrying out the activities 
described in subsection (b), the Secretary may make grants to public 
and private non-profit entities.
    ``(e) Coordination of Effort.--The Secretary shall ensure the 
adequate coordination of the activities carried out under this section.
    ``(f) Authorization of Appropriations.--There is authorized to be 
appropriated such sums as may be necessary for each of fiscal years 
2002 through 2006 to carry out this section.

       ``Part C--Grants With Respect to State Stroke Care Systems

``SEC. 2821. ESTABLISHMENT OF PROGRAM FOR IMPROVING STROKE CARE.

    ``(a) Grants.--The Secretary shall award grants to States for the 
purpose of establishing statewide stroke prevention, treatment, and 
rehabilitation systems.
    ``(b) Use of Funds.--
            ``(1) In general.--The Secretary shall make available 
        grants under subsection (a) for the development and 
        implementation of statewide stroke care systems that provide 
        stroke prevention services and quality acute, post-acute, and 
        rehabilitation care for stroke patients through the development 
        of sufficient resources and infrastructure, including personnel 
        with appropriate training, acute stroke teams, equipment, and 
        procedures necessary to prevent stroke and to treat and 
        rehabilitate stroke patients. In developing and implementing 
        statewide stroke care systems, each State that is awarded such 
        a grant shall--
                    ``(A) oversee the design and implementation of the 
                statewide stroke care system;
                    ``(B) enhance, develop, and implement model 
                curricula for training emergency medical services 
                personnel, including dispatchers, first responders, 
                emergency medical technicians, and paramedics in the 
                identification, assessment, stabilization, and 
                prehospital treatment of stroke patients;
                    ``(C) ensure that stroke patients in the State have 
                access to quality care that is consistent with the 
                standards established by the Secretary under section 
                2823(c);
                    ``(D) establish a support network to provide 
                assistance to facilities with smaller populations of 
                stroke patients or less advanced on-site stroke 
                treatment resources; and
                    ``(E) carry out any other activities that the 
                State-designated agency determines are useful or 
                necessary for the implementation of the statewide 
                stroke care system.
            ``(2) Access to care.--A State may meet the requirement of 
        paragraph (1)(C) by--
                    ``(A) identifying acute stroke centers with 
                personnel, equipment, and procedures adequate to 
                provide quality treatment to patients in the acute 
                phase of stroke consistent with the standards 
                established by the Secretary under section 2823(c);
                    ``(B) identifying comprehensive stroke centers with 
                advanced personnel, equipment, and procedures to 
                prevent stroke and to treat stroke patients in the 
                acute and post-acute phases of stroke and to provide 
                assistance to area facilities with less advanced stroke 
                treatment resources;
                    ``(C) identifying stroke rehabilitation centers 
                with personnel, equipment, and procedures to provide 
                quality rehabilitative care to stroke patients 
                consistent with the standards established by the 
                Secretary under section 2823(c); or
                    ``(D) carrying out any other activities that the 
                designated State agency determines are necessary or 
                useful.
            ``(3) Support network.--A facility that provides care to 
        stroke patients and that receives support through a support 
        network established under paragraph (1)(D) shall meet the 
        standards and requirements outlined by the State application 
        under paragraph (2) of section 2823(b). The support network may 
        include--
                    ``(A) the use of telehealth technology connecting 
                facilities described in such paragraph to more advanced 
                stroke care facilities;
                    ``(B) the provision of neuroimaging, lab, and any 
                other equipment necessary to facilitate the 
                establishment of a telehealth network;
                    ``(C) the use of phone consultation, where useful;
                    ``(D) the use of referral links when a patient 
                needs more advanced care than is available at the 
                facility providing initial care; and
                    ``(E) any other assistance determined appropriate 
                by the State.
    ``(c) Planning Grants.--
            ``(1) In general.--The Secretary may award a grant to a 
        State to assist such State in formulating a plan to develop a 
        statewide stroke care system or in otherwise meeting the 
        conditions described in subsection (b) with respect to a grant 
        under this section.
            ``(2) Submission to secretary.--The governor of a State 
        that receives a grant under paragraph (1) shall submit to the 
        Secretary a copy of the plan developed using the amounts 
        provided under such grant. Such plan shall be submitted to the 
        Secretary as soon as practicable after the plan has been 
        developed.
            ``(3) Single grant limitation.--To be eligible to receive a 
        grant under paragraph (1), a State shall not have previously 
        received a grant under such paragraph.
    ``(d) Model Curriculum.--
            ``(1) Development.--The Secretary shall develop a model 
        curriculum for training emergency medical services personnel, 
        including dispatchers, first responders, emergency medical 
        technicians, and paramedics in the identification, assessment, 
        stabilization, and prehospital treatment of stroke patients.
            ``(2) Implementation.--The model curriculum developed under 
        paragraph (1) may be implemented by a State to fulfill the 
        requirements of subsection (b)(1)(B).

``SEC. 2822. 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 award grants under 
        section 2821(a) unless the State involved agrees, with respect 
        to the costs described in paragraph (2), to make available for 
        each year during which the State receives funding under such 
        section, non-Federal contributions (in cash or in kind under 
        subsection (b)(1)) toward such costs in an amount equal to--
                    ``(A) for the second and third fiscal years of such 
                payments to the State, not less than $1 for each $3 of 
                Federal funds provided in such payments for each such 
                fiscal year;
                    ``(B) for the fourth fiscal year of such payments 
                to the State, not less than $1 for each $2 of Federal 
                funds provided in such payments for such fiscal year; 
                and
                    ``(C) for any subsequent 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.
            ``(2) Program costs.--The costs referred to in paragraph 
        (1) are the costs to be incurred by the State in carrying out 
        the purpose described in section 2821(b).
            ``(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 2821(a) for the 
        first fiscal year of such payments to the State.
    ``(b) Determination of Amount of Non-Federal Contributions.--With 
respect to compliance under subsection (a) as a condition of receiving 
payments under section 2811(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 by a significant extent by the Federal Government.

``SEC. 2823. APPLICATION REQUIREMENTS.

    ``(a) Requirement of Application.--The Secretary may not award a 
grant to a State under section 2821(b) unless an application for the 
grant is submitted by the State to the Secretary.
    ``(b) Application Process and Guidelines.--The Secretary shall 
provide for an application process and develop guidelines to assist 
States in submitting an application under this section that--
            ``(1) outlines the stroke care system and explains how such 
        system will ensure that stroke patients throughout the State 
        have access to quality care in all phases of stroke, consistent 
        with the standards established by the Secretary under 
        subsection (c);
            ``(2) contains standards and requirements for facilities in 
        the State that provide basic preventive services, advanced 
        preventive services, acute stroke care, post-acute stroke care, 
        and rehabilitation services to stroke patients; and
            ``(3) provides for the establishment of a central data 
        reporting and analysis system and for the collection of data 
        from each facility that will provide direct care to stroke 
        patients in the State--
                    ``(A) to identify the number of stroke patients 
                treated in the State;
                    ``(B) to monitor patient care in the State for 
                stroke patients at all phases of stroke for the purpose 
                of evaluating the diagnosis, treatment, and treatment 
                outcome of such stroke patients;
                    ``(C) to identify the total amount of uncompensated 
                and under-compensated stroke care expenditures for each 
                fiscal year by each stroke care facility in the State;
                    ``(D) to identify the number of acute stroke 
                patients who receive advanced drug therapy;
                    ``(E) to identify patients transferred within the 
                statewide stroke care system, including reasons for 
                such transfer; and
                    ``(F) to communicate to the greatest extent 
                practicable with the Paul Coverdell National Acute 
                Stroke Registry and Clearinghouse.
    ``(c) Certain Standards With Respect to Statewide Stroke Care 
System.--
            ``(1) In general.--The Secretary may not award a grant to a 
        State under section 2821(a) for a fiscal year unless the State 
        agrees that, in carrying out paragraphs (2) and (3), the State 
        will--
                    ``(A) adopt standards of care for stroke patients 
                in the acute, post-acute, and rehabilitation phases of 
                stroke; and
                    ``(B) in adopting the standards described in 
                subparagraph (A)--
                            ``(i) consult with medical, surgical, and 
                        nursing specialty groups, hospital 
                        associations, voluntary health organizations, 
                        State offices of rural health, emergency 
                        medical services State and local directors, 
                        experts in the use of telecommunications 
                        technology to provide stroke care, concerned 
                        advocates, and other interested parties;
                            ``(ii) conduct hearings on the proposed 
                        standards providing adequate notice to the 
                        public concerning such hearing; and
                            ``(iii) beginning in fiscal year 2004, take 
                        into account the national standards of care.
            ``(2) Quality of stroke care.--The highest quality of 
        stroke care shall be the primary goal of the State standards 
        adopted under this subsection.
            ``(3) Approval by secretary.--The Secretary may not make 
        payments to a State under section 2821(a) if the Secretary 
        determines that--
                    ``(A) the State has not taken into account national 
                standards in adopting standards under this subsection;
                    ``(B) in the case of payments for fiscal year 2004 
                and subsequent fiscal years, the State has not, in 
                adopting such standards, taken into account the 
                national standards of care and the model system plan 
                developed under subsection (c); or
                    ``(C) in the case of payments for fiscal year 2004 
                and subsequent fiscal years, the State has not provided 
                to the Secretary the information received by the State 
                pursuant to paragraphs (9) and (10) of subsection (a).
    ``(d) Model Stroke Care System Plan.--Not later than 1 year after 
the date of enactment of the Stroke Treatment and Ongoing Prevention 
Act of 2002, the Secretary shall develop standards of care for stroke 
patients in all phases of stroke that may be adopted for guidance by 
the State and a model plan for the establishment of statewide stroke 
care systems. Such plan shall--
            ``(1) take into account national standards;
            ``(2) take into account existing State systems and plans; 
        and
            ``(3) take into account the unique needs of urban and rural 
        communities, different regions of the Nation, and States with 
        varying degrees of established stroke care infrastructures;

``SEC. 2824. REQUIREMENT OF SUBMISSION OF APPLICATION CONTAINING 
              CERTAIN AGREEMENTS AND ASSURANCES.

    ``The Secretary may not award grants under section 2821(a) to a 
State for a fiscal year unless--
            ``(1) the State submits an application for the payments 
        containing agreements in accordance with this part;
            ``(2) the agreements are made through certification from 
        the chief executive officer of the State;
            ``(3) with respect to such agreements, the application 
        provides assurances of compliance satisfactory to the 
        Secretary;
            ``(4) the application contains the plan provisions and the 
        information required to be submitted to the Secretary pursuant 
        to section 2823; and
            ``(5) the application otherwise 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 part.

``SEC. 2825. RESTRICTIONS ON USE OF PAYMENTS.

    ``(a) In General.--The Secretary may not, except as provided in 
subsection (b), make payments to a State under section 2821(a) for a 
fiscal year unless the State involved agrees that the payments will not 
be expended--
            ``(1) to make cash payments to intended recipients of 
        services provided pursuant to such section;
            ``(2) to satisfy any requirement for the expenditure of 
        non-Federal funds as a condition for the receipt of Federal 
        funds; or
            ``(3) 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 2821(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. 2826. FAILURE TO COMPLY WITH AGREEMENTS.

    ``(a) Repayment of Payments.--
            ``(1) Requirement.--The Secretary may, in accordance with 
        subsection (b), require a State to repay any payments received 
        by the State pursuant to section 2821(a) that the Secretary 
        determines were not expended by the State in accordance with 
        the agreements required to be made by the State as a condition 
        of the receipt of payments under such section.
            ``(2) Offset of amounts.--If a State fails to make a 
        repayment required in paragraph (1), the Secretary may offset 
        the amount of the repayment against any amount due to be paid 
        to the State under section 2821(a).
    ``(b) Opportunity for a Hearing.--Before requiring repayment of 
payments under subsection (a)(1), the Secretary shall provide to the 
State an opportunity for a hearing.

``SEC. 2827. SPECIAL CONSIDERATION.

    ``In awarding grants under this part, the Secretary shall give 
special consideration to any State that has submitted an application 
for carrying out programs under such a grant--
            ``(1) in geographic areas in which there is--
                    ``(A) a substantial rate of disability resulting 
                from stroke; or
                    ``(B) a substantial incidence of stroke; or
            ``(2) that demonstrates a significant need for assistance 
        in establishing a comprehensive stroke care system.

``SEC. 2828. TECHNICAL ASSISTANCE AND PROVISION BY SECRETARY OF 
              SUPPLIES AND SERVICES IN LIEU OF GRANT FUNDS.

    ``(a) Technical Assistance.--The Secretary shall, without charge to 
a State receiving payments under section 2821(a), provide to the State 
(or to any public or nonprofit entity designated by the State) 
technical assistance with respect to the planning, development, and 
operation of any program carried out pursuant to section 2821(b). The 
Secretary may provide such technical assistance directly, through 
contract, or through grants.
    ``(b) Provision by Secretary of Supplies and Services in Lieu of 
Grant Funds.--
            ``(1) In general.--Upon the request of a State receiving 
        payments under section 2821(a), the Secretary may, subject to 
        paragraph (2), provide supplies, equipment, and services for 
        the purpose of aiding the State in carrying out section 2821(b) 
        and, for such purpose, may detail to the State any officer or 
        employee of the Department of Health and Human Services.
            ``(2) Reduction in payments.--With respect to a request 
        described in paragraph (1), the Secretary shall reduce the 
        amount of payments to the State under section 2821(a) by an 
        amount equal to the costs of detailing personnel and the fair 
        market value of any supplies, equipment, or services provided 
        by the Secretary. The Secretary shall, for the payment of 
        expenses incurred in complying with such request, expend the 
        amounts withheld.

``SEC. 2829. REPORT BY SECRETARY.

    ``Not later than 3 years after the date of enactment of the Stroke 
Treatment and Ongoing Prevention Act of 2002, the Secretary shall 
report to the appropriate committees of Congress on the activities of 
the States carried out pursuant to section 2821. Such report shall 
include an assessment of the extent to which Federal and State efforts 
to develop stroke care systems, including the establishment of support 
networks and the identification of acute, comprehensive, and 
rehabilitation stroke centers, where applicable, have increased the 
number of stroke patients who have received acute stroke consultation 
or therapy within the appropriate timeframe and reduced the level of 
disability due to stroke. Such report may include any recommendations 
of the Secretary for appropriate administrative and legislative 
initiatives with respect to stroke care.

``SEC. 2830. FUNDING.

    ``(a) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this part, $50,000,000 for fiscal year 2002, 
$75,000,000 for fiscal year 2003, $75,000,000 for fiscal year 2004, 
$100,000,000 for fiscal year 2005, and $125,000,000 for fiscal year 
2006.
    ``(b) Limitation on Administrative Expenses.--A State may use not 
to exceed 10 percent of amounts received under a grant awarded under 
section 2821(a) for administrative expenses.

                    ``Part D--Miscellaneous Programs

``SEC. 2831. MEDICAL PROFESSIONAL DEVELOPMENT IN ADVANCED STROKE 
              TREATMENT AND PREVENTION.

    ``(a) In General.--The Secretary may make grants to public and non-
profit private entities for the development and implementation of 
education programs for appropriate medical personnel including medical 
students, emergency physicians, primary care providers, neurologists, 
neurosurgeons, and physical therapists in the use of newly developed 
diagnostic approaches, technologies, and therapies for the prevention 
and treatment of stroke.
    ``(b) Distribution of Grants.--In awarding grants under subsection 
(a), the Secretary shall ensure that such grants are equitably 
distributed among the geographical regions of the United States and 
between urban and rural populations.
    ``(c) Application.--A public or non-profit private entity desiring 
a grant under subsection (a) shall prepare and submit to the Secretary 
an application at such time, in such manner, and containing such 
information as the Secretary may require, including a plan for the 
rigorous evaluation of activities carried out with amounts received 
under such a grant.
    ``(d) Use of Funds.--A public or non-profit private entity shall 
use amounts received under a grant under this section for the 
continuing education of appropriate medical personnel in the use of 
newly developed diagnostic approaches, technologies, and therapies for 
the prevention and treatment of stroke.
    ``(e) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section, such sums as may be necessary 
for each of fiscal years 2002 through 2006.

      ``Part E--General Provisions Regarding Parts A, B, C, and D

``SEC. 2841. DEFINITIONS.

    ``In this title:
            ``(1) State.--The term `State' means each of the several 
        States, the District of Columbia, the Commonwealth of Puerto 
        Rico, the Indian tribes, the Virgin Islands, Guam, American 
        Samoa, and the Commonwealth of the Northern Mariana Islands.
            ``(2) Stroke care system.--The term `stroke care system' 
        means a statewide system to provide for the diagnosis, 
        prehospital care, hospital definitive care, and rehabilitation 
        of stroke patients.
            ``(3) Stroke.--The term `stroke' means a `brain attack' in 
        which blood flow to the brain is interrupted or in which a 
        blood vessel or aneurysm in the brain breaks or ruptures.

``SEC. 2842. CONSULTATIONS.

    ``In carrying out this title, the Secretary shall consult with 
medical, surgical, rehabilitation, and nursing specialty groups, 
hospital associations, voluntary health organizations, emergency 
medical services, State directors, and associations, experts in the use 
of telecommunication technology to provide stroke care, national 
disability and consumer organizations representing individuals with 
disabilities and chronic illnesses, concerned advocates, and other 
interested parties.''.

            Passed the Senate February 6, 2002.

            Attest:

                                                  JERI THOMSON,

                                                             Secretary.