[Congressional Bills 110th Congress]
[From the U.S. Government Publishing Office]
[S. 657 Introduced in Senate (IS)]







110th CONGRESS
  1st Session
                                 S. 657

 To amend the Public Health Service Act to add requirements regarding 
                  trauma care, and for other purposes.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                           February 16, 2007

Mr. Reed (for himself, Mr. Roberts, Mr. Kennedy, Mr. Burr, Mrs. Murray, 
  Mr. Hatch, Mr. Brown, Mrs. Clinton, Mr. Isakson, Mr. Bingaman, Ms. 
 Collins, and Mr. Biden) introduced the following bill; which was read 
 twice and referred to the Committee on Health, Education, Labor, and 
                                Pensions

_______________________________________________________________________

                                 A BILL


 
 To amend the Public Health Service Act to add requirements regarding 
                  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 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 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) 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 the 
        pediatric trauma patient;
            ``(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 
                concerning that outline resources for optimal care of 
                the injured patient;
                    ``(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 subparagraph (A) 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)(1) 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, 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 making grants under part A. If 
the amount so appropriated is greater than $1,000,000, 50 percent of 
such appropriation shall be made available for grants under part A and 
50 percent shall be made available for grants under part B.
    ``(c) 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 1202, the Secretary shall make available 10 percent of 
        the amounts appropriated for a fiscal year under subsection 
        (a).''.

SEC. 13. INSTITUTE OF MEDICINE STUDY.

    Part E of title XII of the Public Health Service Act (20 U.S.C. 
300d-51 et seq.) is amended by adding at the end the following:

``SEC. 1254. INSTITUTE OF MEDICINE STUDY.

    ``(a) In General.--The Secretary shall enter into a contract with 
the Institute of Medicine of the National Academy of Sciences, or 
another appropriate entity, to conduct a study on the state of trauma 
care and trauma research.
    ``(b) Content.--The study conducted under subsection (a) shall--
            ``(1) examine and evaluate the state of trauma care and 
        trauma systems research (including the role of Federal entities 
        in trauma research) on the date of enactment of this section, 
        and identify trauma research priorities;
            ``(2) examine and evaluate the clinical effectiveness of 
        trauma care and the impact of trauma care on patient outcomes, 
        with special attention to high-risk groups, such as children, 
        the elderly, and individuals in rural areas;
            ``(3) examine and evaluate trauma systems development and 
        identify obstacles that prevent or hinder the effectiveness of 
        trauma systems and trauma systems development;
            ``(4) examine and evaluate alternative strategies for the 
        organization, financing, and delivery of trauma care within an 
        overall systems approach; and
            ``(5) examine and evaluate the role of trauma systems and 
        trauma centers in preparedness for mass casualties.
    ``(c) Report.--Not later than 2 years after the date of enactment 
of this section, the Secretary shall submit to the appropriate 
committees of Congress a report containing the results of the study 
conducted under this section.
    ``(d) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section $750,000 for fiscal year 
2008.''.

SEC. 14. 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 in 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. 15. 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'' .
                                 <all>