1.This Act may be cited as the
Stroke Treatment and Ongoing
Prevention Act of 2007
.
2.
(a)The
Congress finds as follows:
(1)Stroke is the
third leading cause of death in the United States. Each year approximately
700,000 Americans suffer a new or recurrent stroke and over 160,000 Americans
die from stroke.
(2)Stroke costs the
United States $35,000,000,000 in direct costs and $56,800,000,000 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 4,700,000 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. Frequently, stroke patients wait as
many as 22 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)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.
3.Amendment
regarding stroke prevention, treatment, and rehabilitationTitle III of the
Public Health Service Act (42 U.S.C.
241 et seq.) is amended by adding at the end the following:
SStroke prevention,
treatment, and rehabilitation programs
IAuthorities and
duties of the Secretary
399HH.Responsibilities
of the Secretary
(a)The Secretary shall, with respect to stroke care—
(1)establish and
evaluate a grant program under section 399JJ to enable States 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;
(3)provide to State
and local agencies technical assistance;
(4)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;
(5)issue
recommendations or guidelines on best practices for the establishment and
operation of statewide stroke systems, including recommendations or guidelines
on best practices for the establishment and operation of stroke care centers;
and
(6)provide, to the
extent practicable, information to the public on the recognition of the signs
and symptoms of stroke and the appropriate actions to take to assist an
individual in obtaining appropriate and timely care following a stroke.
(b)Grants,
cooperative agreements, and contractsThe Secretary may make
grants, and enter into cooperative agreements and contracts, for the purpose of
carrying out subsection (a).
(c)
(1)Nothing in subsection (a)(5) shall be construed to
require the Secretary to issue new recommendations or guidelines where existing
recommendations or guidelines issued or adopted by the Secretary are applicable
to the establishment of statewide stroke systems. Where an existing
recommendation or guideline is applicable to the establishment of statewide
stroke systems, the Secretary may deem such recommendation or guideline to have
been issued under subsection (a)(5).
(2)Advisory nature
of guidelinesRecommendations or guidelines issued under
subsection (a)(5) shall be considered advisory in nature and shall not be
construed to constitute a standard of care for the treatment of stroke.
399II.Paul
Coverdell National Acute Stroke RegistryThe Secretary shall maintain the Paul
Coverdell National Acute Stroke Registry 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
develop a national registry model that measures 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 high-quality prevention,
acute treatment, post-acute treatment, and rehabilitation services for stroke
patients; and
(5)carrying out any
other activities the Secretary determines to be useful to fulfill the purposes
of the Paul Coverdell National Acute Stroke Registry.
IIState stroke care
systems
399JJ.Grants to
States for stroke care systems
(a)The
Secretary shall award grants to States for the development and implementation
of stroke care systems that provide high-quality prevention, diagnosis,
treatment, and rehabilitation.
(b)
(1)In carrying out activities described in subsection (a),
each State that is awarded a grant under this section shall—
(A)establish,
enhance, or expand a statewide stroke care system for the purpose of ensuring
access to high-quality stroke prevention, diagnosis, treatment, and
rehabilitation, except that activities conducted under this subparagraph shall
be consistent with guidelines or recommendations issued by the Secretary under
section 399HH(a)(5) to the extent that such guidelines or recommendations have
been issued;
(B)establish,
enhance, or expand, as appropriate, stroke care centers, except that activities
conducted under this subparagraph shall be consistent with guidelines or
recommendations issued by the Secretary under section 399HH(a)(5), to the
extent that such guidelines or recommendations have been issued;
(C)conduct evaluation
activities to monitor clinical outcomes and procedures and to verify resources,
infrastructure, and operations devoted to stroke care;
(D)enhance, develop,
and implement model curricula for training emergency medical services personnel
in the identification, assessment, stabilization, and prehospital treatment of
stroke patients which may, at the discretion of the State, consist of or be
based on the model curriculum developed by the Secretary under section
399HH(a)(4);
(E)enhance
coordination of emergency medical services with respect to stroke care;
(F)establish,
enhance, or improve a central data reporting and analysis system described in
subsection (c);
(G)establish,
enhance, or improve a support network described in subsection (d) to provide
assistance to facilities with smaller populations of stroke patients or less
advanced on-site stroke treatment resources;
(H)consult with
organizations and individuals with expertise in stroke prevention, diagnosis,
treatment, and rehabilitation; and
(I)with respect to
carrying out subparagraph (C) through (H), use the best available evidence and
consensus recommendations of professional associations.
(2)In developing and implementing a stroke care system
described in paragraph (1), each State that is awarded a grant under this
section may—
(A)improve existing
State stroke prevention programs;
(B)conduct a stroke
education and information campaign, including by—
(i)making public
service announcements about the warning signs of stroke and the importance of
treating stroke as a medical emergency; and
(ii)providing
education regarding ways to prevent stroke and the effectiveness of stroke
treatment; and
(C)make grants to
public and non-profit private entities for medical professional development in
accordance with subsection (e).
(c)Central data
reporting and analysis systemA central data reporting and
analysis system described in this subsection is a system that collects data
from facilities that provide direct care to stroke patients and uses the
data—
(1)to identify the
number of stroke patients treated in the State;
(2)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;
(3)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;
(4)to identify the
number of acute stroke patients who receive advanced drug therapy;
(5)to identify
patients transferred within the statewide stroke care system, including reasons
for such transfer; and
(6)to communicate to
the greatest extent practicable with the Paul Coverdell National Acute Stroke
Registry.
(d)A support network described in this subsection may
include the following:
(1)The use of
telehealth technology to connect facilities described in subsection (b)(1)(G)
to more advanced stroke care facilities.
(2)The provision of
neuroimaging, laboratory, and any other equipment necessary to facilitate the
establishment of a telehealth network.
(3)The use of phone
consultation, where useful.
(4)The use of
referral links when a patient needs more advanced care than is available at the
facility providing initial care.
(5)Any other
assistance determined appropriate by the State.
(e)Medical
professional development in advanced stroke treatment and prevention
(1)A State may use funds received under a grant under this
section to make subgrants to public and non-profit private entities for the
development and implementation of education programs for appropriate medical
personnel and health professionals in the use of newly developed diagnostic
approaches, technologies, and therapies for the prevention and treatment of
stroke.
(2)A public or non-profit private entity shall use amounts
received under a subgrant under this subsection 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.
(3)Distribution of
subgrantsIn awarding subgrants under this subsection, the
Secretary shall ensure that such subgrants are equitably distributed among the
geographical regions of the State and between urban and rural
populations.
(4)A
public or non-profit private entity desiring a subgrant under this subsection
shall prepare and submit to the State involved an application at such time, in
such manner, and containing such information as the State may require,
including a plan for the rigorous evaluation of activities carried out with
amounts received under such a subgrant.
(f)Restrictions on
use of paymentsThe Secretary may not, except as provided in
paragraph (2), make payments to a State under this section for a fiscal year
unless the State agrees that the payments will not be expended—
(1)to make cash
payments to intended recipients of services provided pursuant to this
section;
(2)to satisfy any
requirement for the expenditure of non-Federal funds as a condition for the
receipt of Federal funds;
(3)to provide
financial assistance to any entity other than a public or nonprofit private
entity; or
(4)for construction,
alteration, or improvement of any building or facility.
(g)Failure To
comply with agreements
(1)
(A)The
Secretary may, in accordance with paragraph (2), require a State to repay any
payments received by the State under this section 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.
(B)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 this section.
(2)Opportunity for
a hearingBefore requiring repayment of payments under paragraph
(1), the Secretary shall provide to the State an opportunity for a
hearing.
(h)The Secretary may not award a grant to a State under
this section unless—
(1)the State submits
an application containing agreements in accordance with this section;
(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; 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 section.
(i)The Secretary shall, without charge to a State
receiving payments under this section, 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 this section. The Secretary may provide such technical assistance directly,
through contract, or through grants.
(j)Supplies and
services in lieu of grant funds
(1)Upon the request of a State receiving payments under this
section, the Secretary may, subject to paragraph (2), provide supplies,
equipment, and services to the State and may detail to the State any officer or
employee of the Department of Health and Human Services, for the purpose of
assisting the State to achieve the purpose of the payments.
(2)With respect to a request described in paragraph (1),
the Secretary shall reduce the amount of payments to the State under this
section 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.
(k)Not
later than 3 years after the date of the enactment of the Stroke Treatment and
Ongoing Prevention Act of 2007, the Secretary shall report to the appropriate
committees of the Congress on the activities of the States carried out pursuant
to this section and section 399KK. Such report shall include an assessment of
the extent to which Federal and State efforts to identify stroke centers,
develop support networks, and enhance emergency medical services coordination
and the training of emergency medical personnel, 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.
(l)Limitation on
administrative expensesThe Secretary may not award a grant to a
State under this section unless the State agrees to use not more than 10
percent of amounts received under the grant for administrative expenses.
399KK.
(a)The
Secretary may award a grant to a State to assist such State in formulating a
plan to develop a stroke care system in accordance with section 399JJ or in
otherwise meeting the requirements of such section.
(b)The chief executive officer of a State that receives a
grant under this section 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.
(c)A State is not eligible to receive a grant under this
section if the State previously received a grant under this section.
399LL.In awarding
grants under this subpart, 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)an elevated
incidence or prevalence of disability resulting from stroke; or
(B)an elevated
incidence or prevalence of stroke; or
(2)that demonstrates
a significant need for assistance in establishing a comprehensive stroke care
system.
III
399MM.
(a)In
carrying out this part, the Secretary shall consult with organizations and
individuals with expertise in stroke prevention, diagnosis, treatment, and
rehabilitation.
(b)In
this part:
(1)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)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)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.
(c)Authorization of
appropriationsThere are authorized to be appropriated to carry
out this part such sums as may be necessary for fiscal years 2008 through
2012.
.
1.This Act may be cited as the
Stroke Treatment and Ongoing
Prevention Act of 2008
.
2.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.
3.Amendment regarding
stroke prevention, treatment, and rehabilitationTitle III of the
Public Health Service Act (42 U.S.C.
241 et seq.) is amended by adding at the end the following:
SStroke prevention,
treatment, and rehabilitation programs
IAuthorities and duties of
the Secretary
399HH.Responsibilities of
the Secretary
(a)The Secretary may, with respect to stroke care—
(1)establish and evaluate a
grant program under section 399JJ to enable States or consortia of States to
develop stroke care systems;
(2)foster the development of
systems of stroke care through total quality improvement of health systems
providing primary stroke prevention and identification, treatment, and
rehabilitation of individuals who experience a stroke;
(3)provide to State,
consortia of States, and local agencies technical assistance; and
(4)collaborate with
appropriate medical and health professional associations to disseminate
evidenced-based practices on stroke systems of care.
(b)Grants, cooperative
agreements, and contractsThe Secretary may make grants, and
enter into cooperative agreements and contracts, for the purpose of carrying
out subsection (a).
399II.Sense of the Senate
concerning the Paul Coverdell National Acute Stroke RegistryIt is the sense of the Senate that, as
evidenced by the Paul Coverdell National Acute Stroke Registry, the Secretary
considers stroke systems of care when allocating discretionary funds relating
to stroke.
IIState or consortia of
States stroke care systems
399JJ.Grants to States or
consortia of States for stroke care systems
(a)The
Secretary may award grants to States or consortia of States for the development
and implementation of stroke care systems that provide high-quality prevention,
diagnosis, treatment, and rehabilitation.
(b)
(1)In carrying out activities described in subsection (a),
each State or consortia of States that is awarded a grant under this section
shall—
(A)establish, enhance, or
expand a statewide stroke care system for the purpose of promoting the total
quality improvement of stroke care consistent with evidence-based
practices;
(B)establish, enhance, or
expand, as appropriate, stroke care centers, except that activities conducted
under this subparagraph shall be consistent with evidence-based
practices;
(C)conduct evaluation
activities to monitor clinical outcomes and procedures and mechanisms for
evaluating the effectiveness of the resources, infrastructure, and operations
devoted to stroke care;
(D)enhance, develop, and
implement effective methods for training emergency medical services personnel
in the identification, assessment, stabilization, and prehospital treatment of
stroke patients;
(E)enhance coordination of
emergency medical services, ground transportation services, and air
transportation with respect to stroke care;
(F)establish, enhance, or
improve a support network described in subsection (c) to provide assistance to
facilities with smaller populations of stroke patients or less advanced on-site
stroke treatment resources;
(G)consult with
organizations and individuals with expertise in stroke prevention, diagnosis,
treatment, and rehabilitation; and
(H)with respect to carrying
out subparagraph (C) through (H), use the best available evidence and consensus
recommendations of professional associations.
(2)In developing and implementing a stroke care system
described in paragraph (1), each State or consortia of States that is awarded a
grant under this section may—
(A)improve existing stroke
prevention programs;
(B)conduct a stroke
education and information campaign, including by—
(i)making public service
announcements about the warning signs of stroke and the importance of treating
stroke as a medical emergency; and
(ii)providing education
regarding ways to prevent stroke and the effectiveness of stroke treatment;
and
(C)make grants to public and
non-profit private entities for medical professional development in accordance
with subsection (d).
(3)With
respect to a grantee under this section that is a consortium of States, nothing
in this section shall be construed to require each of the member States of such
consortium to carry out each of the activities described in subsection (b)(1).
In such cases, the member States of the consortium shall allocate the
activities described under subsection (b)(1) among the member States of the
consortium in such a manner as to best promote the goal of regional
cooperation.
(c)A support network described in this subsection may
include the following:
(1)The use of telehealth
technology to connect facilities described in subsection (b)(1)(G) to more
advanced stroke care facilities. To the extent practicable, such technology
shall be consistent with standards and implementation specifications used for
the direct exchange of health information and adopted by the President.
(2)The use of phone
consultation, where useful.
(3)The use of referral links
when a patient needs more advanced care than is available at the facility
providing initial care.
(4)The use of any other
assistance determined appropriate by the Secretary.
(d)Medical professional
development in advanced stroke treatment and prevention
(1)A State or consortia of States may use funds received
under a grant under this section to make subgrants to public and non-profit
private entities for the development and implementation of education programs
for appropriate medical personnel and health professionals in the use of
evidence-based diagnostic approaches, technologies, and therapies for the
prevention and treatment of stroke.
(2)A public or non-profit private entity shall use amounts
received under a subgrant under this subsection for the continuing education of
appropriate medical personnel in the use of evidence-based diagnostic
approaches, technologies, and therapies for the prevention and treatment of
stroke.
(3)Distribution of
subgrantsIn awarding subgrants under this subsection, the
Secretary shall ensure that such subgrants are equitably distributed with
special consideration given to rural areas or areas that are underserved by
medical specialists within a State or consortia of States.
(4)A
public or non-profit private entity desiring a subgrant under this subsection
shall prepare and submit to the State or State consortia involved an
application at such time, in such manner, and containing such information as
the State or State consortia involved may require, including a plan for the
rigorous evaluation of activities carried out with amounts received under such
a subgrant.
(e)Restrictions on use of
paymentsThe Secretary may not make payments to a State or
consortia of States under this section for a fiscal year unless the State or
consortia agrees that the payments will not be expended—
(1)to make cash payments to
intended recipients of services provided pursuant to this section;
(2)to satisfy any
requirement for the expenditure of non-Federal funds as a condition for the
receipt of Federal funds;
(3)to provide financial
assistance to any entity other than a public or nonprofit private entity;
or
(4)for construction,
alteration, or improvement of any building or facility.
(f)Failure To comply with
agreements
(1)
(A)The
Secretary may, in accordance with paragraph (2), require a State or consortia
of States to repay any payments received by the State or consortia under this
section that the Secretary determines were not expended by the State or
consortia in accordance with the agreements required to be made by the State or
consortia as a condition of the receipt of payments.
(B)If a State or consortia of States 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 or consortia under
this section.
(2)Opportunity for a
hearingBefore requiring repayment of payments under paragraph
(1), the Secretary shall provide to the State or consortia of States an
opportunity for a hearing.
(g)The Secretary may not award a grant to a State or
consortia of States under this section unless—
(1)the State or consortia
submits an application containing agreements in accordance with this
section;
(2)the agreements are made
through certification from the chief executive officer of the State or States
involved;
(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; 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 section.
(h)The Secretary may, without charge to a State or
consortia of States receiving payments under this section, provide to the State
or consortia (or to any public or nonprofit entity designated by the State or
consortia) technical assistance with respect to the planning, development, and
operation of any program carried out pursuant to this section. The Secretary
may provide such technical assistance directly, through contract, or through
grants.
(i)Supplies and services
in lieu of grant funds
(1)Upon the request of a State or consortia of States
receiving payments under this section, the Secretary may, subject to paragraph
(2), provide supplies, equipment, and services to the State or consortia and
may detail to the State or consortia any officer or employee of the Department
of Health and Human Services, for the purpose of assisting the State or
consortia to achieve the purpose of the payments.
(2)With respect to a request described in paragraph (1),
the Secretary shall reduce the amount of payments to the State or consortia of
States under this section 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.
(j)Not
later than 3 years after the date of the enactment of the Stroke Treatment and
Ongoing Prevention Act of 2007, the Secretary may report to the appropriate
committees of the Congress on the activities of the States or consortia of
States carried out pursuant to this section and section 399KK. Such report
shall include an assessment of the extent to which Federal and State efforts to
identify stroke centers, develop support networks, and enhance emergency
medical services coordination and the training of emergency medical personnel,
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.
(k)Limitation on
administrative expensesThe Secretary may not award a grant to a
State or consortia of States under this section unless the State or consortia
agrees to use not more than 10 percent of amounts received under the grant for
administrative expenses.
399KK.In awarding
grants under this subpart, the Secretary may give special consideration to any
State or consortia of States that has submitted an application for carrying out
programs under such a grant—
(1)in geographic areas in
which there is—
(A)an elevated incidence or
prevalence of disability resulting from stroke;
(B)an elevated incidence or
prevalence of stroke; or
(C)a rural area or area that
is underserved by medical specialists;
(2)that demonstrates a
significant need for assistance in establishing a comprehensive stroke care
system; or
(3)that in the determination
of the Secretary, will enhance regional cooperation.
III
399LL.
(a)In
carrying out this part, the Secretary may consult with organizations and
individuals with expertise in stroke prevention, diagnosis, treatment, and
rehabilitation.
(b)Requirement of matching
funds
(1)The Secretary may not make a grant under this part unless
the State (or consortia of States) involved agrees, with respect to the costs
to be incurred by the State (or consortia) in carrying out the purpose for
which such grant was made, to make available non-Federal contributions (in cash
or in kind under paragraph (2)) toward such costs in an amount equal to not
less than $1 for each $3 of Federal funds provided in the grant. Such
contributions may be made directly or through donations from public or private
entities.
(2)Determination of amount
of non-Federal contribution
(A)Non-Federal contributions required in paragraph (1) may
be in cash or in kind, fairly evaluated, including equipment or services (and
excluding indirect or overhead costs). Amounts provided by the Federal
Government, or services assisted or subsidized to any significant extent by the
Federal Government, may not be included in determining the amount of such
non-Federal contributions.
(B)In making a determination of the amount of non-Federal
contributions for purposes of paragraph (1), the Secretary may include only
non-Federal contributions in excess of the average amount of non-Federal
contributions made by the State (or consortia) involved toward the purpose for
which the grant was made for the 2-year period preceding the first fiscal year
for which the State (or consortia) is applying to receive a grant under this
part.
(c)Amounts appropriated under this section shall be used to
supplement and not supplant other Federal, State, and local public funds
provided for activities under this part.
(d)In
this part:
(1)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)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)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.
(e)Authorization of
appropriationsThere are authorized to be appropriated to carry
out this part such sums as may be necessary for fiscal years 2008 through
2012.
.
April 16, 2008
Reported with an amendment