[Congressional Bills 111th Congress]
[From the U.S. Government Publishing Office]
[H.R. 936 Introduced in House (IH)]

111th CONGRESS
  1st Session
                                H. R. 936

 To ensure the continued and future availability of lifesaving trauma 
 health care in the United States and to prevent further trauma center 
closures and downgrades by assisting trauma centers with uncompensated 
  care costs, core mission services, emergency needs, and information 
                              technology.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                           February 10, 2009

   Mr. Towns (for himself, Mr. Burgess, Ms. Castor of Florida, Mrs. 
    Blackburn, Mr. Honda, Mr. Wu, and Mr. Grijalva) introduced the 
   following bill; which was referred to the Committee on Energy and 
                                Commerce

_______________________________________________________________________

                                 A BILL


 
 To ensure the continued and future availability of lifesaving trauma 
 health care in the United States and to prevent further trauma center 
closures and downgrades by assisting trauma centers with uncompensated 
  care costs, core mission services, emergency needs, and information 
                              technology.

    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 ``National Trauma Center Stabilization 
Act of 2009''.

SEC. 2. FINDINGS.

    The Congress finds the following:
            (1) Victims of traumatic injury should have access to 
        lifesaving care regardless of their geographic location or 
        ability to pay. Major multisystem trauma victims receiving care 
        within the first hour following their injury are substantially 
        more likely to survive.
            (2) Maintaining a strong and effective trauma care system 
        for all victims of traumatic injury requires the availability 
        of a sufficient number of trauma centers at appropriate levels 
        of trauma care capability in all geographic regions of the 
        Nation.
            (3) Regional trauma centers annually treat 678,000 
        patients, regardless of their ability to pay. When a trauma 
        victim cannot afford treatment, the trauma center pays for care 
        that may save the victim's life.
            (4) The cost of delivering trauma care has steadily 
        increased during the last decade. Trauma centers collectively 
        have accrued $230,000,000 per year in losses for treating 
        victims who are uninsured or whose care is reimbursed well 
        below the cost of providing care, putting the Nation's trauma 
        care system at-risk.
            (5) Substantial uncompensated care costs are distressing 
        trauma centers and threatening the availability of lifesaving 
        trauma services in numerous areas across the Nation. Since 
        2000, 19 hospitals have closed their trauma centers, and 10 
        others have downgraded their trauma service by 1 or 2 levels.
            (6) At a time when the threat of mass emergencies is high, 
        financial pressures are placing trauma centers at serious risk. 
        Trauma centers are required to respond to mass emergencies 
        including natural disasters, large-scale accidents, and 
        terrorist attacks. Trauma centers maintain a constant state of 
        readiness to serve distressed victims. Trauma centers must also 
        maintain additional capacity and strong health care facility 
        connections with the local and regional emergency care 
        community to serve their regions.
            (7) Many trauma centers lack information technology that 
        could improve the efficiency and effectiveness of trauma care 
        delivery and decrease the costs of providing care by 
        facilitating patient tracking and information flow, and 
        strengthening patient information sharing within the trauma 
        center and coordination among other health care providers. 
        Connecting trauma care centers using health information 
        technology is a part of the efforts to make health information 
        technology available especially in medically underserved 
        communities.

SEC. 3. GRANTS FOR CERTAIN TRAUMA CENTERS.

    (a) Grants for Certain Trauma Centers.--Section 1241 of the Public 
Health Service Act (42 U.S.C. 300d-41) is amended to read as follows:

``SEC. 1241. GRANTS FOR CERTAIN TRAUMA CENTERS.

    ``(a) In General.--The Secretary shall establish 4 programs to 
award grants to trauma centers meeting the qualifications described in 
subsection (b). Of the 4 programs--
            ``(1) one shall be for grants to assist in defraying 
        substantial uncompensated care costs;
            ``(2) one shall be for grants to further the core mission 
        of the trauma center, including by defraying costs associated 
        with patient stabilization and transfer, trauma education and 
        outreach, coordination with local and regional trauma systems, 
        and essential personnel and other fixed costs;
            ``(3) one shall be for grants to provide emergency relief 
        to ensure continued and future availability of trauma service 
        by--
                    ``(A) trauma centers at risk of closing or losing 
                capacity to deliver trauma care;
                    ``(B) centers operating in an area where a closing 
                or loss of trauma service availability has occurred 
                within their primary service area; or
                    ``(C) centers in need of financial assistance after 
                the area in which they are located is affected by a 
                natural disaster or other catastrophic event, such as a 
                terrorist attack; and
            ``(4) one shall be for grants to support the development 
        and maintenance of innovative information technology systems, 
        including through the use of electronic health records and by 
        facilitating the interconnection of trauma care facilities 
        (including Internet-based connectivity) with other local and 
        regional health facilities, for the purpose of--
                    ``(A) improving information sharing and 
                coordination between trauma centers, ambulances, 
                helicopters, and other health care providers, such as 
                physician practitioners, community health centers, and 
                rehabilitation facilities, to facilitate continuity of 
                care for trauma patients throughout their recovery; and
                    ``(B) improving patient tracking and information 
                flow within trauma centers and between health 
                facilities (including developing, updating, and 
                maintaining databases) to improve the overall delivery 
                of trauma care and community health care.
    ``(b) Minimum Qualifications of Centers.--
            ``(1) Participation in trauma care system operating under 
        certain professional guidelines.--Subject to paragraph (2), the 
        Secretary may not make a grant under subsection (a) unless the 
        trauma center involved is a participant in a system that--
                    ``(A) provides comprehensive medical care to 
                victims of trauma in the geographic area in which the 
                trauma center is located;
                    ``(B) is established by the State or political 
                subdivision in which such center is located; and
                    ``(C) has either adopted State guidelines for the 
                designation of trauma centers, and for triage, 
                transfer, and transportation policies, or adopted 
                guidelines equivalent to (or more protective than) the 
                applicable trauma care designated guidelines developed 
                by the American College of Surgeons or utilized in the 
                model plan established under section 1213(c).
            ``(2) Exception.--The requirements of paragraph (1) do not 
        apply with respect to a trauma center located in a State with 
        no existing trauma care system described in such paragraph.
            ``(3) Public or nonprofit status.--The Secretary may not 
        make a grant under paragraph (1), (2), or (4) of subsection (a) 
        unless the trauma center involved is a public or nonprofit 
        entity.
            ``(4) Levels of care.--The Secretary may not make a grant 
        under subsection (a)(1) (relating to uncompensated care costs) 
        unless the trauma center demonstrates to the Secretary's 
        satisfaction at least one of the following:
                    ``(A) At least 20 percent of the visits in the 
                emergency department of the hospital in which the 
                trauma center is located are ones for which there is no 
                insurance coverage or other third-party payment.
                    ``(B) At least 40 percent of the visits in such 
                emergency department are ones for which there either is 
                no such coverage or payment or for which such coverage 
                or payment is provided only under the Medicaid program 
                under title XIX of the Social Security Act.
                    ``(C) The average annual uncompensated care costs 
                in such hospital that are attributable to visits for 
                which there is no insurance coverage or other third-
                party payment is at least $5,000,000 during each of the 
                3 most recent fiscal years before the first fiscal year 
                for which the center is applying for the grant.
                    ``(D) The trauma center qualifies for funds under a 
                low-income pool or safety net care pool established 
                through a waiver approved under section 1115 of the 
                Social Security Act.
    ``(c) Submission and Approval of Long-Term Plan.--The Secretary may 
not make a grant under subsection (a)(1) of this section unless the 
trauma center involved--
            ``(1) submits to the Secretary a plan satisfactory to the 
        Secretary that--
                    ``(A) is developed on the assumption that the 
                center will continue to incur substantial uncompensated 
                care costs in providing trauma care;
                    ``(B) provides for the long-term continued 
                operation of the center at similar or greater levels of 
                medical care than in prior years notwithstanding such 
                uncompensated care costs;
            ``(2) agrees to implement the plan according to a schedule 
        approved by the Secretary; and
            ``(3) demonstrates that such center has policies in place--
                    ``(A) to assist patients who cannot pay for all or 
                part of the care they received, including a sliding fee 
                scale; and
                    ``(B) to ensure fair billing and collection 
                practices.''.
    (b) Preferences in Making Grants.--Section 1242 of the Public 
Health Service Act (42 U.S.C. 300d-42) is amended to read as follows:

``SEC. 1242. PREFERENCE IN MAKING GRANTS.

    ``(a) Substantial Uncompensated Care Costs.--In making grants under 
section 1241(a)(1), the Secretary shall--
            ``(1) reserve 95 percent of the amounts allocated pursuant 
        to subsections (b)(1) and (c) of section 1246 for grants to 
        level I and level II trauma centers;
            ``(2) reserve 5 percent of the amounts allocated pursuant 
        to subsections (b)(1) and (c) of section 1246 for grants to 
        level III and level IV trauma centers;
            ``(3) if there are not sufficient qualifying centers to 
        obligate the 95 percent reservation in paragraph (1) or the 5 
        percent reservation in paragraph (2), reallocate the funds for 
        grants under section 1241(a)(1) to other qualifying centers; 
        and
            ``(4) subject to paragraphs (1), (2), and (3), ensure that 
        funding for grants under section 1241(a)(1) is divided equally 
        among qualified applicants.
    ``(b) Core Mission.--In making grants under section 1241(a)(2), the 
Secretary shall--
            ``(1) reserve 25 percent of the amount allocated pursuant 
        to section 1246(b)(2) for grants to level III and level IV 
        trauma centers, but shall reallocate the funds to level I and 
        level II centers if there are not sufficient qualifying level 
        III and IV centers to obligate the 25 percent set-aside; and
            ``(2) give preference to--
                    ``(A) any application made by a trauma center in a 
                geographic area where growth in demand for trauma 
                services exceeds capacity, as determined by the 
                Secretary based on such factors as local and regional 
                population trends, loss or downgrading of neighborhood 
                trauma centers, loss or reduction of physician trauma 
                specialty availability, high malpractice liability 
                costs, or the necessity to provide physician on-call 
                pay; or
                    ``(B) any application made by a trauma center which 
                demonstrates State or political subdivision financial 
                support.
        For any of the purposes specified in section 1241(a)(2) for 
        each fiscal year during which payments are made to the center 
        from the grant, such financial support may be demonstrated by, 
        but is not limited to, State or political subdivision funding 
        for the trauma center's capital or operating expenses including 
        through State trauma regional advisory coordination activities 
        or Medicaid funding under title XIX of the Social Security Act 
        designated for trauma services, or other governmental funding. 
        State funding derived from Federal support provided through the 
        Trauma Systems Planning Grants provided to States or political 
        subdivisions does not constitute State or local financial 
        support for purposes of preferential treatment under this 
        section.
    ``(c) Emergency Relief.--In making grants under section 1241(a)(3), 
the Secretary--
            ``(1) shall give preference to any application made by a 
        trauma center that--
                    ``(A) is providing trauma care in a geographic area 
                in which the availability of trauma care has either 
                significantly decreased as a result of a trauma center 
                in the area permanently ceasing participation in such 
                system as of the date on which the application is 
                submitted, or where growth in demand for trauma 
                services exceeds capacity, as determined by the 
                Secretary based on such factors as local and regional 
                population trends, loss or downgrading of neighboring 
                trauma centers, loss or reduction of physician 
                specialty availability, high malpractice liability 
                costs, or the necessity to provide physician on-call 
                pay;
                    ``(B) will, in providing trauma care during the 1-
                year period beginning on the date on which the 
                application for the grant is submitted, incur 
                uncompensated care costs in an amount rendering the 
                center unable to continue participation in such system, 
                resulting in a significant decrease in the availability 
                of trauma care in the geographic area;
                    ``(C) operates in a rural area where trauma care 
                availability will significantly decrease if the trauma 
                center is forced to close or downgrade service and 
                uncompensated care costs are contributing to a 
                likelihood of closure or downgrade; or
                    ``(D) the Secretary determines warrants financial 
                assistance if the trauma center is in a geographic 
                location substantially affected by a natural disaster 
                or other catastrophic event such as a terrorist attack; 
                and
            ``(2) shall reallocate any funds available for grants under 
        section 1241(a)(3), but not awarded due to insufficient or a 
        lack of qualified applications, to grants under section 
        1241(a)(1).
    ``(d) Information Technology.--In making grants under section 
1241(a)(4), the Secretary shall--
            ``(1) make grants only to applicants who are eligible to 
        receive a grant under section 1241(a)(1);
            ``(2) give preference to qualified applicants who--
                    ``(A) demonstrate the greatest financial need; and
                    ``(B) are level I or level II centers; and
            ``(3) not make an award less than $1,000,000 for a fiscal 
        year unless such award would cover the full cost of an 
        applicant's proposed project.
    ``(e) Designations of Levels of Trauma Centers in Certain States.--
In the case of a State which has not designated 4 levels of trauma 
centers in the manner described in this section, any reference in this 
section to--
            ``(1) a level I or level II trauma center is deemed to be a 
        reference to a trauma center within the highest two levels of 
        trauma centers designated under State guidelines; and
            ``(2) a level III or IV trauma center is deemed to be a 
        reference to a trauma center not within such highest two 
        levels.''.
    (c) Certain Agreements.--Section 1243 of the Public Health Service 
Act (42 U.S.C. 300d-43) is amended to read as follows:

``SEC. 1243. CERTAIN AGREEMENTS.

    ``(a) Commitment Regarding Continued Participation in Trauma Care 
System.--The Secretary may not make a grant under section 1241(a)(1) 
(relating to uncompensated care costs) unless the trauma center 
involved agrees that--
            ``(1) the center will continue participation in the system 
        described in section 1241(b)(1), except as provided in section 
        1241(b)(2), throughout the grant period; and
            ``(2) if the center violates the agreement made pursuant to 
        paragraph (1), the center will be liable to the United States 
        for an amount equal to the sum of--
                    ``(A) the amount of assistance provided to the 
                center under section 1241(a) for the fiscal year 
                involved; and
                    ``(B) an amount representing interest on the amount 
                specified in subparagraph (A).
    ``(b) Period of Certain Grants.--The period of a grant under 
section 1241(a)(3) (relating to emergency relief) shall be 3 fiscal 
years, except that the Secretary may waive the application of this 
subsection to a trauma center and authorize the center to receive 
payments under such section for 1 additional fiscal year.
    ``(c) Maintenance of Financial Support.--With respect to activities 
for which a grant under section 1241 is authorized to be expended, the 
Secretary may not make such a grant unless the trauma center involved 
agrees that, during the grant period, the center will maintain access 
to trauma services at levels not less than the prior year, taking into 
account reasonable volume fluctuation not caused by--
            ``(1) intentional trauma boundary reduction or downgrading 
        of level; or
            ``(2) diversion of services in excess of 5 percent.
    ``(d) Supplement, Not Supplant.--The Secretary may not make a grant 
under section 1241 unless the trauma center involved agrees that funds 
received through the grant will be used to supplement and not supplant 
funding otherwise available for the activities and costs described in 
such section.
    ``(e) Trauma Care Registry.--The Secretary may not make a grant 
under section 1241(a) unless the trauma center involved agrees that--
            ``(1) the center will--
                    ``(A) operate a registry of trauma cases in 
                accordance with guidelines developed by the American 
                College of Surgeons or similar guidelines applicable to 
                the center in the State involved; and
                    ``(B) begin operation of the registry not later 
                than 6 months after the date on which the center 
                submits to the Secretary the application for the grant; 
                and
            ``(2) in carrying out paragraph (1), the center will 
        maintain information on the number of trauma cases treated by 
        the center and, for each such case, the extent to which the 
        center incurs uncompensated care costs in providing trauma 
        care.''.
    (d) General Provisions.--Section 1244 of the Public Health Service 
Act (42 U.S.C. 300d-44) is amended to read as follows:

``SEC. 1244. GENERAL PROVISIONS.

    ``(a) Application.--The Secretary may not make a grant under 
section 1241(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 part.
    ``(b) Limitation on Amount of Grant.--The amount of a grant under 
section 1241 for a fiscal year may not exceed $2,000,000.
    ``(c) Eligibility.--Receipt of or eligibility for a grant under any 
1 of the 4 grant programs described in section 1241(a) shall not 
preclude a trauma center from receipt of or eligibility for a grant 
under any of the other programs described in such section.
    ``(d) Notice of Eligibility.--The Secretary shall annually 
determine and notify trauma centers of their eligibility to receive a 
grant under section 1241.
    ``(e) Report.--Beginning 2 years after the date of enactment of the 
National Trauma Center Stabilization Act of 2009, and every 2 years 
thereafter, the Secretary shall--
            ``(1) report to the Congress on the status of the grants 
        made pursuant to section 1241;
            ``(2) evaluate and report to the Congress on the overall 
        financial stability of trauma centers in the United States;
            ``(3) report on the populations using trauma care centers 
        and include aggregate patient data on income, race, ethnicity, 
        and geography; and
            ``(4) evaluate the effectiveness and efficiency of trauma 
        care center activities using standard public health measures 
        and evaluation methodologies.''.
    (e) Definition.--Part D of title XII of the Public Health Service 
Act (42 U.S.C. 300d-41 et seq.) is amended--
            (1) by redesignating section 1245 as section 1246; and
            (2) by inserting after section 1244 the following:

``SEC. 1245. UNCOMPENSATED CARE COSTS DEFINED.

    ``In this part, the term `uncompensated care costs' means, with 
respect to a hospital, unreimbursed costs of the hospital from serving 
patients for which there is either no insurance coverage or other 
third-party payment or for which such coverage or payment is provided 
only under the Medicaid program under title XIX of the Social Security 
Act, which are attributable to emergency care and trauma care in the 
hospital--
            ``(1) including costs related to inpatient admissions to 
        the hospital subsequent to receiving such care in the hospital; 
        and
            ``(2) excluding payments under section 1923 of the Social 
        Security Act.''.
    (f) Authorizations of Appropriations.--Section 1246 of the Public 
Health Service Act, as redesignated by subsection (e), is amended to 
read as follows:

``SEC. 1246. AUTHORIZATIONS OF APPROPRIATIONS.

    ``(a) In General.--For the purpose of carrying out this part, there 
are authorized to be appropriated--
            ``(1) with respect to grants under paragraphs (1), (2), and 
        (3) of section 1241(a), $100,000,000 for each of fiscal years 
        2010 through 2015; and
            ``(2) with respect to grants under paragraph (4) of section 
        1241(a), $25,000,000 for each of fiscal years 2010 through 
        2015.
Authorizations of appropriations pursuant to this section are in 
addition to any other authorizations of appropriations available for 
carrying out this part.
    ``(b) Funding Distribution.--Of the amount appropriated pursuant to 
subsection (a)(1) for a fiscal year, the Secretary shall reserve--
            ``(1) 70 percent for grants under section 1241(a)(1) 
        (relating to substantial uncompensated care costs);
            ``(2) 20 percent for grants under section 1241(a)(2) 
        (relating to the core mission of a trauma center); and
            ``(3) 10 percent for grants under section 1241(a)(3) 
        (relating to emergency relief).
    ``(c) Minimum Amount for Substantial Uncompensated Care Costs.--
Notwithstanding subsection (b), if the amount appropriated pursuant to 
subsection (a)(1) for a fiscal year is less than $25,000,000, such 
amount shall be used exclusively for grants under section 
1241(a)(1).''.
    (g) Conforming Amendment.--The heading of part D of title XII of 
the Public Health Service Act (42 U.S.C. 300d-41 et seq.) is amended to 
read as follows:

             ``Part D--Grants for Certain Trauma Centers''.

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