[Congressional Bills 108th Congress]
[From the U.S. Government Publishing Office]
[H.R. 3513 Introduced in House (IH)]






108th CONGRESS
  1st Session
                                H. R. 3513

   To amend the Public Health Service Act to direct the Secretary of 
Health and Human Services to expand and intensify programs with respect 
  to research and related activities concerning elder falls, and for 
                            other purposes.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                           November 18, 2003

 Mr. Pallone introduced the following bill; which was referred to the 
                    Committee on Energy and Commerce

_______________________________________________________________________

                                 A BILL


 
   To amend the Public Health Service Act to direct the Secretary of 
Health and Human Services to expand and intensify programs with respect 
  to research and related activities concerning elder falls, and for 
                            other purposes.

    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 ``Elder Fall Prevention Act of 
2003''.

SEC. 2. FINDINGS.

     The Congress finds as follows:
            (1) Falls are the leading cause of injury deaths among 
        people over 65.
            (2) By 2030, the population of individuals who are 65 years 
        of age or older will double. By 2050, the population of 
        individuals who are 85 years of age or older will quadruple.
            (3) In 2000, falls among elderly individuals accounted for 
        10,200 deaths and 1,600,000 emergency department visits.
            (4) Sixty percent of fall-related deaths occur among 
        persons 75 and older.
            (5) Twenty-five percent of elderly persons who sustain a 
        hip fracture die within 1 year.
            (6) Hospital admissions for hip fractures among the elderly 
        have increased from 231,000 admissions in 1988 to 332,000 in 
        1999. The number of hip fractures is expected to exceed 500,000 
        by 2040.
            (7) Annually, more than 64,000 individuals who are over 65 
        years of age sustain a traumatic brain injury as a result of a 
        fall.
            (8) Annually, 40,000 individuals who are over 65 years of 
        age visit emergency departments with traumatic brain injuries 
        suffered as a result of a fall, of which 16,000 of these 
        individuals are hospitalized and 4,000 of these individuals 
        die.
            (9) The rate of fall-induced traumatic brain injuries for 
        individuals who are 80 years of age or older increased by 60 
        percent from 1989 to 1998.
            (10) The estimated total cost for non-fatal traumatic brain 
        injury-related hospitalizations for falls in individuals who 
        are 65 years of age or older is more than $3,250,000,000. Two-
        thirds of these costs occurred among individual who were 75 
        years of age or older.
            (11) The costs to the Medicare and Medicaid programs and 
        society as a whole from falls by elderly persons continue to 
        climb much faster than inflation and population growth. Direct 
        costs alone will exceed $32,000,000,000 in 2020.
            (12) The Federal Government should devote additional 
        resources to research regarding the prevention and treatment of 
        falls in residential as well as institutional settings.
            (13) A national approach to reducing elder falls, which 
        focuses on the daily life of senior citizens in residential, 
        institutional, and community settings is needed. The approach 
        should include a wide range of organizations and individuals 
        including family members, health care providers, social 
        workers, architects, employers and others.
            (14) Reducing preventable adverse events, such as elder 
        falls, is an important aspect to the agenda to improve patient 
        safety.

SEC. 3. PURPOSES.

     The purposes of this Act are--
            (1) to develop effective public education strategies in a 
        national initiative to reduce elder falls in order to educate 
        the elders themselves, family members, employers, caregivers, 
        and others who touch the lives of senior citizens;
            (2) to expand needed services and gain information about 
        the most effective approaches to preventing and treating elder 
        falls; and
            (3) to require the Secretary of Health and Human Services 
        to evaluate the effect of elder falls on the costs of the 
        Medicare and Medicaid programs and the potential for reducing 
        costs by expanding education, prevention, and elderly 
        intervention services covered or sponsored by these two 
        programs.

SEC. 4. AMENDMENT TO PUBLIC HEALTH SERVICE ACT.

    Title III of the Public Health Service Act (42 U.S.C. 241 et seq.) 
is amended by adding at the end the following part:

                  ``PART R--PREVENTION OF ELDER FALLS

``SEC. 399AA. PUBLIC AND PROFESSIONAL EDUCATION.

    ``(a) In General.--Subject to the availability of appropriations, 
the Secretary shall--
            ``(1) oversee and support a three-year national education 
        campaign to be carried out by the National Safety Council to be 
        directed principally to elders, their families, and health care 
        providers and focusing on ways of reducing the risk of elder 
        falls and preventing repeat falls;
            ``(2) provide grants to qualified organizations and 
        institutions for the purpose of organizing State-level 
        coalitions of appropriate State and local agencies, safety, 
        health, senior citizen and other organizations to design and 
        carry out local education campaigns, focusing on ways of 
        reducing the risk of elder falls and preventing repeat falls; 
        and
            ``(3) provide grants and contracts to qualified 
        organizations and institutions for the purpose of providing 
        state-of-the-art continued education to health and allied 
        health professionals to effect geriatric fall prevention.
    ``(b) Definition.--For purposes of this section, the term `allied 
health professionals' has the meaning given such term in section 799B.

``SEC. 399AA-1. RESEARCH.

    ``(a) In General.--Subject to the availability of appropriations, 
the Secretary shall--
            ``(1) conduct and support research to--
                    ``(A) improve the identification of elders with a 
                high risk of falls;
                    ``(B) improve data collection and analysis to 
                identify fall risk and protective factors;
                    ``(C) improve strategies that are proven to be 
                effective in reducing subsequent falls by elderly fall 
                victims;
                    ``(D) expand proven interventions to prevent elder 
                falls;
                    ``(E) improve the diagnosis, treatment, and 
                rehabilitation of elderly fall victims; and
                    ``(F) assess the risk of falls occurring in various 
                settings.
            ``(2) conduct and support research concerning barriers to 
        the adoption of proven interventions with respect to the 
        prevention of elder falls (such as medication review and vision 
        enhancement); and
            ``(3) evaluate the effectiveness of community programs to 
        prevent assisted living and nursing home falls by elders.
    ``(b) Administration.--In carrying out subsection (a), the 
Secretary shall--
            ``(1) conduct research and surveillance activities related 
        to the community-based and populations-based aspects of elder 
        falls prevention through the Director of the Centers for 
        Disease Control and Prevention;
            ``(2) conduct research related to elder fall prevention in 
        health care delivery settings and clinical treatment and 
        rehabilitation of elderly fall victims through the Director of 
        the Agency for Healthcare Research and Quality; and
            ``(3) ensure the coordination of the activities described 
        in paragraphs (1) and (2).
    ``(c) Grants.--The Secretary shall award grants and contracts to 
qualified organizations and institutions to enable such organizations 
and institutions to provide professional education for physicians and 
allied health professionals in elder fall prevention. In awarding these 
grants and contracts, the Secretary shall give appropriate priority to 
projects that show proven capacity to be self supporting within two 
years after the onset of the project.

``SEC. 399AA-2. DEMONSTRATION PROJECTS.

    ``(a) In General.--Subject to the availability of appropriations, 
the Secretary, acting through the Director of the Centers for Disease 
Control and Prevention and in consultation with the Director of the 
Agency for Healthcare Research and Quality, shall carry out the 
following:
            ``(1) Oversee and support demonstration and research 
        projects to be carried out by the National Safety Council in 
        the following areas:
                    ``(A) A multi-State demonstration project assessing 
                the utility of targeted elder-falls risk screening and 
                referral programs.
                    ``(B) Programs targeting newly-discharged fall 
                victims who are at a high risk for second falls, which 
                shall include, but not be limited to modification 
                projects for elders with multiple sensory impairments, 
                video and web-enhanced fall prevention programs for 
                caregivers in multifamily housing settings, and 
                development of technology to prevent and detect falls.
                    ``(C) Private sector and public-private 
                partnerships, involving home remodeling, home design 
                and remodeling (in accordance with accepted building 
                codes and standards) and nursing home and hospital 
                patient supervision.
                    ``(D) Private sector and public-private 
                partnerships to develop technology to prevent falls and 
                prevent or reduce injuries if falls occur.
                    ``(E) Hospital-based geriatric fall prevention and 
                treatment centers.
                    ``(F) Medicaid sponsored community projects for 
                comprehensive geriatric fall prevention of the type 
                recently adopted by the States of Pennsylvania, New 
                York, and Florida whereby Medicaid elders are 
                comprehensively screened, counseled, referred, case 
                managed, and otherwise so treated as to reduce hospital 
                admissions for fall related injuries by 60 percent or 
                more.
                    ``(G) Provide grants to not less than four States 
                and to four hospitals to expand the programs identified 
                in subparagraphs (E) and (F). In selecting State 
                grantees under this subparagraph, the Secretary shall 
                give appropriate priority to States that have adopted 
                legislation that either--
                            ``(i) adopts Medicaid-sponsored 
                        comprehensive fall prevention projects; or
                            ``(ii) requires allied health professional 
                        licensing boards to provide at least 1 hour of 
                        continuing education per year on geriatric fall 
                        prevention.
        In all demonstration projects under this paragraph, the 
        Secretary shall give appropriate priority to projects that show 
        proven capacity to be self supporting within 2 years of the 
        onset of the project.
            ``(2)(A) Provide grants and contracts to qualified 
        organizations and institutions to design and carry out elder 
        falls prevention programs in residential and institutional 
        settings.
            ``(B) Provide one or more grants to one or more qualified 
        applicants in order to carry out a multi-State demonstration 
        project to implement elder falls prevention programs targeted 
        toward multi-family residential settings with high 
        concentrations of elders, including identifying high risk 
        populations, evaluating residential facilities, conducting 
        screening to identify high risk individuals, providing pre-fall 
        counseling, coordinating services with health care and social 
        service providers and coordinating post-fall counseling, 
        treatment, and rehabilitation.
            ``(C) Provide one or more grants to qualified applicants to 
        conduct evaluations of the effectiveness of the demonstration 
        projects in this section.
    ``(b) Definition.--For purposes of this section, the term 
`Medicaid' means the program under title XIX of the Social Security 
Act.

``SEC. 399AA-3. AUTHORIZATION OF APPROPRIATIONS.

    ``(a) In General.--In order to carry out the provisions of this 
part, there are authorized to be appropriated--
            ``(1) to carry out the national public education provisions 
        described in section 399AA(1), $5,000,000 for each of fiscal 
        years 2004 through 2006;
            ``(2) to carry out the State public education campaign 
        provisions of section 399AA(2), $4,000,000 for each of fiscal 
        years 2004 through 2006;
            ``(3) to carry out the professional and educational 
        campaign provision of section 399AA(3), $5,000,000 for each of 
        fiscal years 2004 through 2006;
            ``(4) to carry out research projects described in section 
        399AA-1, $5,000,000 for each of fiscal years 2004 through 2006;
            ``(5) to carry out the demonstration projects described in 
        section 399AA-2(1), $11,000,000 for each of fiscal years 2004 
        through 2006; and
            ``(6) to carry out the demonstration and research projects 
        described in section 399AA-2(2), $8,000,000 for each of fiscal 
        years 2004 through 2006.
    ``(b) Allocation.--In the case of each program for which an 
authorization of appropriations is established in subsection (a) and 
under which program the Secretary is authorized to make awards of 
grants or contracts to private entities, the Secretary shall reserve 
from the amount appropriated under such subsection for the program not 
less than 30 percent for making such awards.''.

SEC. 5. REVIEW OF REIMBURSEMENT POLICIES.

    (a) In General.--The Secretary of Health and Human Services shall 
undertake a review of the effects of elder falls on the costs of the 
programs under titles XVIII and XIX of the Social Security Act 
(referred to in this section as the ``Medicare'' and ``Medicaid'' 
programs, respectively) programs and the potential for reducing costs 
by expanding services covered by these two programs. This review shall 
include a review of the reimbursement policies of Medicare and Medicaid 
in order to determine if additional fall-related education, prevention, 
and early prevention services should be covered or reimbursement 
guidelines should be modified.
    (b) Report.--Not later than 18 months after the date of the 
enactment of this Act, the Secretary of Health and Human Services shall 
submit to the Congress a report describing the findings of the 
Secretary in conducting the review under subsection (a).
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