[Congressional Bills 108th Congress]
[From the U.S. Government Publishing Office]
[H.R. 3999 Introduced in House (IH)]







108th CONGRESS
  2d Session
                                H. R. 3999

To amend the Public Health Service Act with respect to trauma care, and 
                          for other purposes.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             March 18, 2004

Mr. Greenwood (for himself, Mr. Green of Texas, Mr. Bilirakis, and Mr. 
Brown of Ohio) introduced the following bill; which was referred to the 
                    Committee on Energy and Commerce

_______________________________________________________________________

                                 A BILL


 
To amend the Public Health Service Act with respect to trauma care, 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 ``Trauma Research and Access to Urgent 
Medical Attention Act of 2004'' or the ``TRAUMA Act of 2004''.

SEC. 2. AMENDMENT TO TITLE XII OF PUBLIC HEALTH SERVICE ACT.

    Title XII of the Public Health Service Act (42 U.S.C. 300d et seq.) 
is amended--
            (1) by striking part D; and
            (2) by amending parts A, B, and C to read as follows:

                      ``PART A--GENERAL AUTHORITY

``SEC. 1201. GENERAL AUTHORITY AND DUTIES OF THE SECRETARY.

    ``(a) In General.--The Secretary may, with respect to trauma care--
            ``(1) conduct and support research, training, evaluations, 
        and demonstration projects;
            ``(2) foster the development of appropriate, modern systems 
        of trauma 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, including the development of a model plan for the 
        designation of trauma centers and for triage, transfer, and 
        transportation policies; and
            ``(4) sponsor workshops and conferences.
    ``(b) Consultation.--In carrying out this section, the Secretary 
shall consult with appropriate State and professional organizations.

``SEC. 1202. DATA COLLECTION.

    ``(a) In General.--The Director of the Centers for Disease Control 
and Prevention, directly or through grants or contracts, may establish 
and provide for the operation of information systems and provide for 
the collection, coordination, and exchange of information related to 
trauma system development or operation.
    ``(b) Consultation.--In carrying out this section, the Director of 
the Centers for Disease Control and Prevention shall consult with the 
Administrator of the Health Resources and Services Administration and 
such other persons outside of the Centers as the Director deems 
appropriate.

``SEC. 1203. GRANTS TO STATES TO IMPROVE TRAUMA CARE SYSTEMS.

    ``(a) In General.--The Secretary, acting through the Administrator 
of the Health Resources and Services Administration, shall make a 
grant, in the amount referred to in section 1208(c), to each State that 
submits an application and agrees to comply with the requirements of 
this section, for the purpose of improving access to and enhancing the 
development of trauma care systems.
    ``(b) Requirements.--The Secretary may make a grant to a State 
under this section only if the State has developed a plan that--
            ``(1) specifies a public or private entity that will 
        designate trauma care regions and trauma centers in the State;
            ``(2) contains, for the designation of level I, level II, 
        and level III trauma centers, standards and requirements 
        developed by--
                    ``(A) taking into account standards developed by 
                professional organizations and any guidelines or model 
                plans developed by the Secretary with the goal of 
                ensuring the greatest possible access to trauma care 
                and providing the highest quality of trauma care;
                    ``(B) consulting with medical, surgical, and 
                nursing speciality groups, hospital associations, 
                emergency medical services State and local directors, 
                concerned advocates, and other interested parties; and
                    ``(C) conducting public hearings on the proposed 
                standards after providing adequate notice to the public 
                concerning such hearings;
            ``(3) 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;
            ``(4) 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;
            ``(5) utilizes a program with procedures for the evaluation 
        of designated trauma centers (including trauma centers 
        described in paragraph (4)) and trauma care systems;
            ``(6) provides for the establishment and collection of data 
        from each designated trauma center in the State of a central 
        data reporting and analysis system (to be transmitted to the 
        Secretary in accordance with section 1202)--
                    ``(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;
            ``(7) provides for the use of procedures by paramedics and 
        emergency medical technicians to assess the severity of the 
        injuries incurred by trauma patients;
            ``(8) 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;
            ``(9) conducts public education activities concerning 
        injury prevention and obtaining access to trauma care;
            ``(10) 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; and
            ``(11) coordinates planning for trauma systems with State 
        disaster emergency planning and bioterrorism hospital 
        preparedness planning.
    ``(c) Trauma Plan.--
            ``(1) In general.--For each fiscal year, the Secretary may 
        not make payments to a State under this section unless, subject 
        to paragraph (2), 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.
            ``(2) 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 paragraph (1), 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.
            ``(3) Information received by state reporting and analysis 
        system.--The Secretary may not make payments to a State under 
        this section 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 subsection 
        (b)(6).
            ``(4) Availability of emergency medical services in rural 
        areas.--The Secretary may not make payments to a State under 
        this section unless--
                    ``(A) the State identifies any rural area in the 
                State for which--
                            ``(i) there is no system of access to 
                        emergency medical services through the 
                        telephone number 911;
                            ``(ii) there is no basic life-support 
                        system; or
                            ``(iii) there is no advanced life-support 
                        system; and
                    ``(B) the State submits to the Secretary a list of 
                rural areas identified pursuant to subparagraph (A) or, 
                if there are no such areas, a statement that there are 
                no such areas.
    ``(d) Requirement of Matching Funds.--
            ``(1) Non-federal contributions.--
                    ``(A) In general.--The Secretary may not make a 
                grant to a State under this section unless the State 
                agrees, with respect to the costs of carrying out the 
                grant, to make available non-Federal contributions (in 
                cash or in kind under paragraph (2)(A)) toward such 
                costs in an amount equal to--
                            ``(i) for the first and second fiscal year 
                        of payments under this section to the State 
                        after the date of the enactment of the Trauma 
                        Research and Access to Urgent Medical Attention 
                        Act of 2004, not less than $1 for each $1 of 
                        Federal funds provided in such payments for 
                        such fiscal year; and
                            ``(ii) for any subsequent fiscal year of 
                        such payments to the State, not less than $2 
                        for each $1 of Federal funds provided in such 
                        payments for such fiscal year.
            ``(2) Determination of amount of non-federal 
        contribution.--With respect to compliance with paragraph (1)--
                    ``(A) a State may make the non-Federal 
                contributions in cash or in kind, fairly evaluated, 
                including plant, equipment, or staff services; and
                    ``(B) 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.
    ``(e) Restrictions.--
            ``(1) In general.--The Secretary may not make payments to a 
        State under this section unless the State agrees that the 
        payments will not be expended--
                    ``(A) to make cash payments to intended recipients 
                of services provided pursuant to this section;
                    ``(B) to purchase or improve real property (other 
                than minor remodeling of existing improvements to real 
                property); or
                    ``(C) to satisfy any requirement for the 
                expenditure of non-Federal funds as a condition for the 
                receipt of Federal funds.
            ``(2) Waiver.--The Secretary may waive a restriction under 
        paragraph (1) only if the Secretary determines that the 
        activities outlined by the State plan submitted under 
        subsection (c)(1) by the State involved cannot otherwise be 
        carried out.
    ``(f) Application.--To seek a grant under this section, a State 
shall submit to the Secretary an application in such form, in such 
manner, and containing such information and assurances as the Secretary 
may require.
    ``(g) Reports by States.--A grant may be made to a State under this 
section only if the State agrees that, promptly after the end of the 
fiscal year for which the grant is made, the State will submit to the 
Secretary a report that describes the activities of the State under the 
grant.

``SEC. 1204. 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, consortia of States or political 
subdivisions, and accredited schools of medicine 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--
            ``(1) in the case of an application by a State, political 
        subdivision, or consortium, the applicant agrees to use the 
        grant--
                    ``(A) to integrate and broaden the reach of a 
                trauma care system, such as by developing innovative 
                protocols to increase access to prehospital care and 
                equipment necessary for the transportation of seriously 
                injured patients to the appropriate facilities;
                    ``(B) to strengthen, develop, and improve an 
                existing trauma care system;
                    ``(C) to expand and improve emergency medical 
                services for children who need treatment for trauma or 
                critical care;
                    ``(D) to expand communications between the trauma 
                care system and emergency medical services through 
                improved equipment or a telemedicine system;
                    ``(E) to improve data collection and retention; or
                    ``(F) 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; or
            ``(2) in the case of an application by an accredited school 
        of medicine, the applicant agrees to use the grant to expand 
        and improve emergency medical services for children who need 
        treatment for trauma or critical care.
    ``(c) Preference.--In selecting among States, political 
subdivisions, and consortia of States or political subdivisions (but 
not accredited schools of medicine) for purposes of making grants under 
this section, the Secretary shall give preference to applicants that--
            ``(A) have developed a process and adopted standards for 
        designating trauma centers;
            ``(B) recognize protocols for the delivery of seriously 
        injured patients to trauma centers;
            ``(C) implement a process for evaluating the performance of 
        the trauma system; and
            ``(D) 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) Definitions.--For purposes of this section, the terms 
`accredited' and `school of medicine' have the meanings given to those 
terms in section 799B.

``SEC. 1205. REPORTS.

    ``(a) Report by Secretary.--Not later than the end of fiscal year 
2006, the Secretary shall submit a report to the appropriate committees 
of the Congress on the activities of the States carried out with 
assistance under this part. Such report--
            ``(1) 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;
            ``(2) shall include an assessment of the grants awarded 
        under section 1204; and
            ``(3) may include any recommendations of the Secretary to 
        improve trauma care.
    ``(b) Evaluations by Comptroller General.--The Comptroller General 
of the United States--
            ``(1) shall evaluate the expenditures by grantees of 
        payments under section 1203 and section 1204 to assure that 
        such expenditures are consistent with the provisions of such 
        sections; and
            ``(2) not later than December 1, 2006, shall submit to the 
        Committee on Energy and Commerce of the House of 
        Representatives and the Committee on Health, Education, Labor, 
        and Pensions of the Senate a report concerning such evaluation.

``SEC. 1206. RULE OF CONSTRUCTION.

    ``Nothing in this title authorizes the Secretary to establish 
Federal standards for the treatment of patients or the licensure of 
health care professionals.

``SEC. 1207. DEFINITIONS.

    ``For purposes of this part:
            ``(1) Designated trauma center.--The term `designated 
        trauma center' means a trauma center designated in accordance 
        with the provisions of the State plan described in section 
        1203(b).
            ``(2) State plan regarding emergency medical services.--The 
        term `State plan', with respect to the provision of emergency 
        medical services, means a plan for a comprehensive, organized 
        system to provide for the access, response, triage, field 
        stabilization, transport, hospital stabilization, definitive 
        care, and rehabilitation of patients of all ages with respect 
        to emergency medical services.
            ``(3) State.--The term `State' means each of the several 
        States, the District of Columbia, the Commonwealth of Puerto 
        Rico, the Virgin Islands, Guam, American Samoa, and the 
        Commonwealth of the Northern Mariana Islands.
            ``(4) Trauma.--The term `trauma' means an injury resulting 
        from exposure to a mechanical force.
            ``(5) Trauma care component of state plan.--The term 
        `trauma care component', with respect to components of the 
        State plan for the provision of emergency medical services, 
        means a plan for a comprehensive health care system, within 
        rural and urban areas of the State, for the prompt recognition, 
        prehospital care, emergency medical care, acute surgical and 
        medical care, rehabilitation, and outcome evaluation of 
        seriously injured patients.

``SEC. 1208. AUTHORIZATION OF APPROPRIATIONS.

    ``(a) Authorization of Appropriations.--For the purpose of carrying 
out sections 1201, 1202, 1203, and 1204, there is authorized to be 
appropriated $31,000,000 for each of fiscal years 2005 through 2009.
    ``(b) Allocation of Funds.--Of the amount appropriated for each of 
fiscal years 2005 through 2009 under subsection (a)--
            ``(1) if such amount is $12,000,000 or less, the Secretary 
        shall make available 100 percent of such amount for the purpose 
        of carrying out sections 1201, 1202, and 1204; or
            ``(2) if such amount is greater than $12,000,000, the 
        Secretary shall make available 50 percent of such amount for 
        the purpose of carrying out sections 1201, 1202, and 1204 and 
        50 percent of such amount for the purpose of carrying out 
        section 1203.
    ``(c) Determination of Amount of Allotment.--
            ``(1) In general.--For purposes of section 1203(a), the 
        amount referred to in this subsection for a State for a fiscal 
        year is the sum of--
                    ``(A) an amount determined under paragraph (2);
                    ``(B) an amount determined under paragraph (3); and
                    ``(C) any amount allotted to the State under 
                paragraph (4).
            ``(2) Amount relating to population.--The amount referred 
        to in subparagraph (A) of paragraph (1) for a State for a 
        fiscal year is the product of--
                    ``(A) an amount equal to 80 percent of the amounts 
                appropriated under this section to carry out section 
                1203 for the fiscal year; and
                    ``(B) a percentage equal to the quotient of--
                            ``(i) an amount equal to the population of 
                        the State; divided by
                            ``(ii) an amount equal to the population of 
                        all States.
            ``(3) Amount relating to square mileage.--The amount 
        referred to in subparagraph (B) of paragraph (1) for a State 
        for a fiscal year is the product of--
                    ``(A) an amount equal to 20 percent of the amounts 
                appropriated under this section to carry out section 
                1203 for the fiscal year; and
                    ``(B) a percentage equal to the quotient of--
                            ``(i) an amount equal to the lesser of 
                        266,807 or the amount of the square mileage of 
                        the State; divided by
                            ``(ii) an amount equal to the sum of the 
                        respective amounts determined for the States 
                        under clause (i).
            ``(4) Disposition of certain funds appropriated for 
        allotments.--
                    ``(A) In general.--Amounts described in 
                subparagraph (B) shall, in accordance with subparagraph 
                (C), be allotted by the Secretary to States receiving 
                payments under section 1203 for the fiscal year (other 
                than any State referred to in subparagraph (B)(iii)).
                    ``(B) Type of amounts.--The amounts referred to in 
                subparagraph (A) are any amounts that are made 
                available pursuant to this section to carry out section 
                1203, but are not paid to a State as a result of--
                            ``(i) the failure of the State to submit an 
                        application under section 1203;
                            ``(ii) the failure, in the determination of 
                        the Secretary, of the State to prepare within a 
                        reasonable period of time such application in 
                        compliance with such section; or
                            ``(iii) the State informing the Secretary 
                        that the State does not intend to expend the 
                        full amount of the allotment made for the 
                        State.
                    ``(C) Amount.--The amount of an allotment under 
                subparagraph (A) for a State for a fiscal year shall be 
                an amount equal to the product of--
                            ``(i) an amount equal to the amounts 
                        described in subparagraph (B) for the fiscal 
                        year involved; and
                            ``(ii) the percentage equal to the quotient 
                        of an amount equal to the population of the 
                        State, divided by an amount equal to the 
                        population of all States (other than any State 
                        referred to in subparagraph (B)(iii)).
    ``(d) Failure to Comply with Agreements.--
            ``(1) Repayment of payments.--
                    ``(A) Requirement.--The Secretary may, in 
                accordance with paragraph (2), require a State to repay 
                any payments received by the State under section 1203 
                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.
                    ``(B) Offset of amounts.--If a State fails to make 
                a repayment required in subparagraph (A), the Secretary 
                may offset the amount of the repayment against any 
                amount due to be paid to the State under section 1203.
            ``(2) Opportunity for a hearing.--Before requiring 
        repayment of payments under paragraph (1)(A), the Secretary 
        shall provide to the State an opportunity for a hearing.''.

SEC. 3. INTERAGENCY PROGRAM FOR TRAUMA RESEARCH.

    Title IV of the Public Health Service Act (42 U.S.C. 281 et seq.) 
is amended by inserting after section 494A the following:

               ``interagency program for trauma research

    ``Sec. 494B. (a) In General.--The Secretary, acting through the 
Director of NIH, shall establish a comprehensive program of basic and 
clinical research on trauma (in this section referred to as the 
`Program'), including the prevention, diagnosis, treatment, and 
rehabilitation of trauma-related injuries.
    ``(b) Plan for Program.--The Director of NIH shall establish and 
implement a plan for carrying out the activities of the Program, taking 
into consideration the recommendations contained in the report of the 
NIH Trauma Research Taskforce. The plan shall be periodically reviewed, 
and revised as appropriate.
    ``(c) Participating Agencies; Coordination and Collaboration.--The 
Director of NIH--
            ``(1) shall provide for the conduct of activities under the 
        Program by the directors of the agencies of the National 
        Institutes of Health involved in research with respect to 
        trauma;
            ``(2) shall ensure that the activities of the Program are 
        coordinated among such agencies; and
            ``(3) shall, as appropriate, provide for collaboration 
        among such agencies in carrying out such activities.
    ``(d) Certain Activities of Program.--The Program shall include--
            ``(1) studies with respect to all phases of trauma care, 
        including prehospital, resuscitation, surgical intervention, 
        critical care, infection control, wound healing, nutritional 
        care and support, and medical rehabilitation care;
            ``(2) basic and clinical research regarding the response of 
        the body to trauma and the acute treatment and medical 
        rehabilitation of individuals who are the victims of trauma;
            ``(3) basic and clinical research regarding trauma care for 
        pediatric and geriatric patients; and
            ``(4) the authority to make awards of grants or contracts 
        to public or nonprofit private entities for the conduct of 
        basic and applied research regarding traumatic brain injury, 
        which research may include--
                    ``(A) the development of new methods and modalities 
                for the more effective diagnosis, measurement of degree 
                of brain injury, post-injury monitoring, and prognostic 
                assessment of head injury for acute, subacute, and 
                later phases of care;
                    ``(B) the development, modification, and evaluation 
                of therapies that retard, prevent, or reverse brain 
                damage after traumatic brain injury, that arrest 
                further deterioration following injury, and that 
                provide the restitution of function for individuals 
                with long-term injuries;
                    ``(C) the development of research on a continuum of 
                care from acute care through rehabilitation, designed, 
                to the extent practicable, to integrate rehabilitation 
                and long-term outcome evaluation with acute care 
                research;
                    ``(D) the development of programs that increase the 
                participation of academic centers of excellence in 
                traumatic brain injury treatment and rehabilitation 
                research and training; and
                    ``(E) carrying out subparagraphs (A) through (D) 
                with respect to cognitive disorders and neurobehavioral 
                consequences arising from traumatic brain injury, 
                including the development, modification, and evaluation 
                of therapies and programs of rehabilitation toward 
                reaching or restoring normal capabilities in areas such 
                as reading, comprehension, speech, reasoning, and 
                deduction.
    ``(e) Mechanisms of Support.--In carrying out the Program, the 
Director of NIH, acting through the directors of the agencies referred 
to in subsection (c)(1), may make grants to public and nonprofit 
entities, including designated trauma centers.
    ``(f) Resources.--The Director of NIH shall assure the availability 
of appropriate resources to carry out the Program, including the plan 
established under subsection (b) and the activities described in 
subsection (d).
    ``(g) Definitions.--For purposes of this section:
            ``(1) The term `designated trauma center' has the meaning 
        given such term in section 1207.
            ``(2) The term `trauma' means any serious injury that could 
        result in loss of life or in significant disability and that 
        would meet prehospital triage criteria for transport to a 
        designated trauma center.
            ``(3) The term `traumatic brain injury' means an acquired 
        injury to the brain. Such term does not include brain 
        dysfunction caused by congenital or degenerative disorders, nor 
        birth trauma, but may include brain injuries caused by anoxia 
        due to trauma. The Secretary may revise the definition of such 
        term as the Secretary determines necessary, after consultation 
        with States and other appropriate public or nonprofit private 
        entities.
    ``(h) Authorization of Appropriations.--For the purpose of carrying 
out this section, there are authorized to be appropriated such sums as 
may be necessary for each of the fiscal years 2005 through 2009.''.

SEC. 4. CONFORMING AMENDMENTS.

    (a) Title XII of Public Health Service Act.--Title XII of the 
Public Health Service Act (42 U.S.C. 300d et seq.) is amended--
            (1) in part E, by resdesignating sections 1251 through 1253 
        as sections 1221 through 1223, respectively;
            (2) by redesignating part E as part B;
            (3) by striking part F;
            (4) in part G, by redesignating sections 1271 through 1274 
        as sections 1231 through 1234, respectively; and
            (5) by redesignating part G as part C.
    (b) Title XIX of Public Health Service Act.--Title XIX of the 
Public Health Service Act (42 U.S.C. 300w et seq.) is amended--
            (1) in subparagraph (C) of section 1904(a)(1), by striking 
        ``section 1213(a)'' and inserting ``section 1203''; and
            (2) by striking section 1910.
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