1.This Act may be cited as
the National Trauma Center
Stabilization Act of 2009
.
2.Congress makes the following
findings:
(1)Victims of traumatic injury should have
access to lifesaving care regardless of their geographic location or ability to
pay. Major multi-system trauma victims receiving care within the first
Golden 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 United States.
(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 their
life.
(4)The cost of delivering trauma care has
steadily increased in the last decade. Trauma centers collectively have
incurred $230,000,000 per year in losses for treating victims who are either
uninsured or whose care is reimbursed well below the cost of providing
care.
(5)Substantial uncompensated care costs are
distressing trauma centers and threatening the availability of life-saving
trauma services in numerous areas across the United States. Since 2000, 20
hospitals have closed their trauma centers, and 13 others have downgraded their
trauma service.
(6)At a time when the threat of mass
emergencies are 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. By their very
nature, trauma centers maintain a constant state of readiness, extra capacity,
and strong healthcare facility connections with the local and regional
emergency care community.
(7)Medical liability exposure and its related
costs have contributed to the closing of trauma centers and downgrading of
trauma levels. It is important to find ways to minimize risk to those who
provide lifesaving care in those initial critical hours following a trauma
event.
(8)The supply of
trauma surgeons in the United States is rapidly declining. Trauma fellowships
are only 60 percent full.
(9)There is a
limited pipeline to replace retiring trauma surgeons and surgical specialists.
The average age of an American College of Surgeons Fellow is 58 years and most
hospitals do not require trauma surgeons to take calls after the age of
60.
(10)A national
survey of surgeons conducted by the Robert Wood Johnson Foundation revealed
that 50 percent of respondents would abandon emergency calls if it were not
mandated to maintain staff privileges.
(11)Increasing
numbers of trauma centers are closing their emergency departments or
downgrading their trauma center designation level due to factors that include a
lack of access to on-call specialists.
(12)The lack of
surgical availability is concentrating trauma care in regional trauma centers
as the only source of surgical specialty care for hundreds of miles for
patients historically cared for in community trauma centers. This causes a lack
of surge capacity and results in an inability to accept severely injured
patients at the regional trauma center level.
<enum>I</enum><header>Trauma care
centers</header>
<section id="id63A560604B35487FBEEA0C2D143ABDD1" section-type="subsequent-section"><enum>101.</enum><header>Grants for trauma
care centers</header><text display-inline="no-display-inline">Section 1241 of
the Public Health Service Act (42 U.S.C. 300d–41) is amended by striking
subsections (a) and (b) and inserting the following:</text>
<quoted-block display-inline="no-display-inline" id="id80005473E0354A63A5E4D77809819CE2" style="OLC">
<subsection id="ID7c2b97921ca4431cbfd79182ec9f360e"><enum>(a)</enum><header>In
general</header><text>The Secretary shall establish 3 programs to award grants
to qualified public, non-profit, Indian Health Service, Indian tribal, and
urban Indian trauma centers—</text>
<paragraph id="ID0a210ea4c8b74c198ea7b6d660f8ad1a"><enum>(1)</enum><text>to assist in
defraying substantial uncompensated care costs as defined in section
1246;</text>
</paragraph><paragraph id="IDf2c84ffeccc84c8d8a7063530cd96bc7"><enum>(2)</enum><text>to further their
core missions, including by addressing 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; and</text>
</paragraph><paragraph id="ID0155d6260e1448b3abac86ae25144ebb"><enum>(3)</enum><text>to provide
emergency relief to ensure the continued and future availability of trauma
services by trauma centers at risk of closing or centers operating in an area
where a closing has occurred within their primary service area.</text>
</paragraph></subsection><subsection id="ID4e88711ec6cc42adb38a7feb29cc37b4"><enum>(b)</enum><header>Minimum
qualifications of trauma centers</header>
<paragraph id="id556EE1D10BB44585AE298521BCD46DEE"><enum>(1)</enum><header>Participation
in trauma care system operating under certain professional
guidelines</header><text>Subject to paragraph (2), the Secretary may not award
a grant to a trauma center under subsection (a) unless the trauma center
involved is a participant in a trauma system that substantially complies with
section 1213.</text>
</paragraph><paragraph id="ID0f251146146d4c258f41424f068367cd"><enum>(2)</enum><header>Exemption</header><text>Paragraph
(1) shall not apply to trauma centers that are located in States with no
existing trauma care system.</text>
</paragraph><paragraph id="ID358af23850b04ba2a1a404d61e9559fc"><enum>(3)</enum><header>Qualification
for substantial uncompensated care costs</header><text>The Secretary shall only
award substantial uncompensated care grants under subsection (a)(1) to trauma
centers meeting at least 1 of the criteria in 1 of the following 3
categories:</text>
<subparagraph id="id42C868FDC074474685C2A9F17EF62966"><enum>(A)</enum><header>Category
A</header><text>The criteria for category A are as follows:</text>
<clause id="id4EE048AE9BAC49B490A1E65018C0E5C1"><enum>(i)</enum><text>At least 50
percent of the visits in the emergency department of the hospital in which the
trauma center is located were charity or self-pay patients.</text>
</clause><clause id="id7FDF6F691FB3478B91D446FF358B06BA"><enum>(ii)</enum><text>At least 70
percent of the visits in such emergency department were Medicaid (title XIX of
the Social Security Act) and charity and self-pay patients combined.</text>
</clause></subparagraph><subparagraph id="id1FBD835DEEB941778285759BE9CA9ED0"><enum>(B)</enum><header>Category
B</header><text>The criteria for category B are as follows:</text>
<clause id="id107053D4184C452C8E36175D5F57E4A9"><enum>(i)</enum><text>At least 35
percent of the visits in such emergency department were charity or self-pay
patients.</text>
</clause><clause id="idB04361BBE5034D19A4441CE8A336BE12"><enum>(ii)</enum><text>At least 50
percent of the visits in such emergency department were Medicaid (title XIX of
the Social Security Act) and charity and self-pay patients combined.</text>
</clause></subparagraph><subparagraph id="id979B9325F9F542749220107F3EE4EE97"><enum>(C)</enum><header>Category
C</header><text>The criteria for category C are as follows:</text>
<clause id="id7BD48BC3CD9745F6BFD9E482F9FF99EB"><enum>(i)</enum><text>At least 20
percent of the visits in such emergency department were charity or self-pay
patients.</text>
</clause><clause id="idF2E7B6A58AA941739AAD4D1ACC017136"><enum>(ii)</enum><text>At least 30
percent of the visits in such emergency department were Medicaid (title XIX of
the Social Security Act) and charity and self pay patients combined.</text>
</clause></subparagraph></paragraph><paragraph id="id1EBEDBCAA506458D87E2187439F2C5AB"><enum>(4)</enum><header>Trauma centers
in 1115 waiver States</header><text>Notwithstanding paragraph (3), the
Secretary may award a substantial uncompensated care grant to a trauma center
under subsection (a)(1) if 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.</text>
</paragraph><paragraph id="id51E51C3D3C184A08A3BB7F76AA844107"><enum>(5)</enum><header>Designation</header><text>The
Secretary may not award a grant to a trauma center unless such trauma center is
verified or designated by the American College of Surgeons or an equivalent
State or local agency.</text>
</paragraph></subsection><subsection id="IDa2c76cb73fdc456db55cb22b1b1c1dad"><enum>(c)</enum><header>Additional
requirements</header><text>The Secretary may not award a grant to a trauma
center under subsection (a)(1) unless the trauma center involved—</text>
<paragraph id="ID30132c4c9db046ce96080b7724d1a7f5"><enum>(1)</enum><text>submits to the
Secretary a plan satisfactory to the Secretary that—</text>
<subparagraph id="ID24eaa34dbe2d4e5e9c979394038cbf1e"><enum>(A)</enum><text>is developed on
the assumption that the center will continue to incur substantial uncompensated
costs in providing trauma care; and</text>
</subparagraph><subparagraph id="IDe36fa4f3162743418eb313977079b557"><enum>(B)</enum><text>provides for the
long-term continued operation of the center at similar or greater levels of
medical care than in prior years notwithstanding such substantial uncompensated
costs;</text>
</subparagraph></paragraph><paragraph id="ID731758c43f8f467f8a8991b62c9042d5"><enum>(2)</enum><text>agrees to
implement the plan according to a schedule approved by the Secretary;
and</text>
</paragraph><paragraph id="id07A0D37F764041648EA3D5114F1782E0"><enum>(3)</enum><text>has policies in
place to assist patients who cannot pay for part or all of the care they
receive, including a sliding fee scale, and to ensure fair billing and
collection
practices.</text>
</paragraph></subsection><after-quoted-block>.</after-quoted-block></quoted-block>
</section><section id="idD1DE28A9D1A445C08F1FC10BE2E574E2"><enum>102.</enum><header>Considerations
in making grants</header><text display-inline="no-display-inline">Section 1242
of the Public Health Service Act (42 U.S.C. 300d–42) is amended by striking
subsections (a) and (b) and inserting the following:</text>
<quoted-block display-inline="no-display-inline" id="id7A945AE1DB04436CB4F4CD5D92E9D801" style="OLC">
<subsection id="ID9197920f0edb4b6698b7f712c8e883a4"><enum>(a)</enum><header>Substantial
Uncompensated Care Awards</header>
<paragraph id="id47910BBDCD2847EC8477F2AE6026660E"><enum>(1)</enum><header>In
general</header><text>The Secretary shall establish an award basis for each
eligible trauma center for grants under section 1241(a)(1) according to the
percentage described in paragraph (2), subject to the requirements of section
1241(b)(3).</text>
</paragraph><paragraph id="id4062EDE5F3B344B7B315580C3ACBE423"><enum>(2)</enum><header>Percentages</header><text>The
applicable percentages are as follows:</text>
<subparagraph id="idA2D509D09F6D44258EABD5DC5DC496E4"><enum>(A)</enum><text>With respect to a
category A trauma center, 100 percent of the uncompensated care costs.</text>
</subparagraph><subparagraph id="idFC7960BEBD754E4499632283B0A1BDD3"><enum>(B)</enum><text>With respect to a
category B trauma center, not to exceed 75 percent of the uncompensated care
costs.</text>
</subparagraph><subparagraph id="id5C4969B43E544616BCCA547FD7152596"><enum>(C)</enum><text>With respect to a
category C trauma center, not to exceed 50 percent of the uncompensated care
costs.</text>
</subparagraph></paragraph></subsection><subsection id="ID617b7db8ca3b430b8f9b6d8dd2e5c2b7"><enum>(b)</enum><header>Core mission
awards</header>
<paragraph id="id3A3DE362666E41B99E6A60769FEE6369"><enum>(1)</enum><header>In
general</header><text>In awarding grants under section 1241(a)(2), the
Secretary shall—</text>
<subparagraph id="IDeb9ebd266bf7435ba48a44ff29a92491"><enum>(A)</enum><text>reserve 25
percent of the amount allocated for core mission awards for Level III and Level
IV trauma centers, and reallocate such amount to Level I and Level II trauma
centers if there are not sufficient qualifying Level III and IV centers to
which such funds may be obligated;</text>
</subparagraph><subparagraph id="id0F7A9596BCC0423A94115E1CE1172F35"><enum>(B)</enum><text>reserve 25
percent of the amount allocated for core mission awards for large urban Level 1
trauma centers that—</text>
<clause id="id73FAC175E96E43FD99A5DD1670A56CF8"><enum>(i)</enum><text>have at least 1
graduate medical education fellowship in trauma or trauma related specialties,
including neurological surgery, surgical critical care, vascular surgery, and
spinal cord injury for which demand is exceeding supply;</text>
</clause><clause id="id0F0DFCC33D6948538565B2B7828EFEEF"><enum>(ii)</enum><text>have either
annual uncompensated care costs exceeding $10,000,000 or where at least 20
percent of emergency department visits are charity or self-pay or Medicaid
patients; and</text>
</clause><clause id="idD36015DF01694DCAAA4F8ADA2C30C663"><enum>(iii)</enum><text>are not
eligible for substantial uncompensated care awards under section 1241(a)(1);
and</text>
</clause></subparagraph><subparagraph id="ID532b53ebf3c24284839d3a5a7dd58903"><enum>(C)</enum><text>give preference
to any application made by a trauma center—</text>
<clause id="id05A2558E923F4C458F7911E3B6667CB4"><enum>(i)</enum><text>in a geographic
area where growth in demand for trauma services exceeds capacity; or</text>
</clause><clause id="ID563a79836a774604bb969e31f94fb745"><enum>(ii)</enum><text>that
demonstrates the financial support of the State or political subdivision
involved.</text>
</clause></subparagraph></paragraph><paragraph id="idA9B04DE9A8C847A9AED573BDF40D01F9"><enum>(2)</enum><header>Financial
support</header><text>For purposes of paragraph (1)(C)(ii), for any of the
purposes specified in section 1241 for each fiscal year during which payments
are made to the trauma center involved from the grant, such financial support
may be demonstrated by 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 designated for trauma
services, or other governmental funding). State funding derived from Federal
support provided through the Trauma Systems Planning Grants awarded to States
or political subdivisions shall not constitute State or local financial support
for purposes of preferential treatment under this subsection.</text>
</paragraph></subsection><subsection id="ID476480054b524a028f17b5b88c43c4b1"><enum>(c)</enum><header>Emergency
awards</header><text>In awarding grants under section 1241(a)(3), the Secretary
shall—</text>
<paragraph id="IDe8604253c14f41148468783a283acac0"><enum>(1)</enum><text>give preference
to any application submitted by a trauma center that demonstrates the financial
support (in accordance with subsection (b)(2)) of the State or political
subdivision involved for any of the purposes specified in section 1241 for each
fiscal year during which payments are made to the center under the
grant;</text>
</paragraph><paragraph id="ID8a7ce005d218422f8d6ad711b495ac9c"><enum>(2)</enum><text>give preference
to any application submitted by a trauma center that—</text>
<subparagraph id="id49F0C16A040B46F48CD5585542AAB382"><enum>(A)</enum><text>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 a date occurring during
the 2-year period preceding the fiscal year for which the trauma center is
applying to receive a grant under section 1241(a)(3), or in geographic areas
where growth in demand for trauma services exceeds capacity;</text>
</subparagraph><subparagraph id="id7A66AE47434B44AAA68331921837D2FD"><enum>(B)</enum><text>will, in
providing trauma care during the 1-year period beginning on the date on which
the application for the grant is submitted, incur substantial uncompensated
costs in an amount that renders the center unable to continue participation in
such system and results in a significant decrease in the availability of trauma
care in the geographic area; or</text>
</subparagraph><subparagraph id="idE0C63C4EC4C547B4854D58B6B0719ECF"><enum>(C)</enum><text>operates in rural
areas where trauma care availability will significantly decrease if the center
is forced to close or downgrade service and substantial uncompensated costs are
contributing to a likelihood of such closure or downgradation; and</text>
</subparagraph></paragraph><paragraph id="ID7550d66ced254b50815dfd03f8a75d90"><enum>(3)</enum><text>reallocate any
emergency awards funds not obligated due to insufficient, or a lack of
qualified, applications to the significant uncompensated care award
program.</text>
</paragraph></subsection><after-quoted-block>.</after-quoted-block></quoted-block>
</section><section id="idC179CCACDB3E42269F4AD230F29B4D60"><enum>103.</enum><header>Certain
agreements</header><text display-inline="no-display-inline">Section 1243 of the
Public Health Service Act (42 U.S.C. 300d–43) is amended by striking
subsections (a), (b), and (c) and inserting the following:</text>
<quoted-block display-inline="no-display-inline" id="idFA4C98D545A84E6A968CBD315933AEE0" style="OLC">
<subsection id="IDca76142b0a5d4a92a8bb6cb35b3387c0"><enum>(a)</enum><header>Commitment
regarding continued participation in trauma care system</header><text>The
Secretary may not award a grant to a trauma center under section 1241(a) unless
the trauma center involved agrees that—</text>
<paragraph id="ID568d1ea35200442fa3dd543e3c135028"><enum>(1)</enum><text>the center will
continue participation in the system described in section 1241(b), except as
provided in subsection (b)(2) of such section, throughout the grant period
beginning on the date that the center first receives payments under the grant;
and</text>
</paragraph><paragraph id="ID1e5ce92e59cc4c6fb94e4b17c2ec21b3"><enum>(2)</enum><text>if the agreement
made pursuant to paragraph (1) is violated by the center, the center will be
liable to the United States for an amount equal to the sum of—</text>
<subparagraph id="idE98B07FAB3C145A49DD3795B390658F4"><enum>(A)</enum><text>the amount of
assistance provided to the center under section 1241(a); and</text>
</subparagraph><subparagraph id="idEA671E3FB0D542F08A25C8D682E04F91"><enum>(B)</enum><text>an amount
representing interest on the amount specified in subparagraph (A).</text>
</subparagraph></paragraph></subsection><subsection id="IDa0b19e3739df4c44968e8018dda2aec6"><enum>(b)</enum><header>Maintenance of
financial support</header><text>With respect to activities for which a grant
awarded under section 1241 are authorized to be expended, the Secretary may not
award such a grant unless the trauma center involved agrees that, during the
period in which the center is receiving payments under the grant, the center
will maintain access to trauma services at levels not less than the levels for
the prior year, taking into account reasonable volume fluctuation that is not
caused by intentional trauma boundary reduction, downgrading of the level of
services, or diversion of services in excess of 5 percent.</text>
</subsection><subsection id="ID67a54ff2c2ed441bb469c4e186040595"><enum>(c)</enum><header>Trauma care
registry</header><text>The Secretary may not award a grant under section
1241(a) unless the trauma center involved agrees that—</text>
<paragraph id="IDe9a82519237e4457a08b846c40a35d71"><enum>(1)</enum><text>not later than 6
months after the date on which the center submits a grant application to the
Secretary, the center will establish and operate a registry of trauma cases in
accordance with guidelines developed by the American College of Surgeons;
and</text>
</paragraph><paragraph id="ID14087acc29fc4de491adf41387c4e670"><enum>(2)</enum><text>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 substantial uncompensated costs in providing trauma
care.</text>
</paragraph></subsection><after-quoted-block>.</after-quoted-block></quoted-block>
</section><section id="idE47A26C8860E44BD9081ABFFE8C4947C"><enum>104.</enum><header>General
provisions</header><text display-inline="no-display-inline">Section 1244 of the
Public Health Service Act (42 U.S.C. 300d–44) is amended by striking
subsections (a), (b), and (c) and inserting the following:</text>
<quoted-block display-inline="no-display-inline" id="id6853450794D04B63B5682FFD594482C4" style="OLC">
<subsection id="ID816517d753b6404285fd97c7fc89a07e"><enum>(a)</enum><header>Application</header><text>The
Secretary may not award a grant to a trauma center under section 1241(a) unless
an application for the grant is submitted by the center 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.</text>
</subsection><subsection id="ID593e1d535f6e45c08b63ff46cad204d4"><enum>(b)</enum><header>Limitation on
duration of support</header><text>The period during which a trauma center
receives payments under a grant under section 1241(a)(3) shall be for 3 fiscal
years, except that the Secretary may waive such requirement for the center and
authorize the center to receive such payments for 1 additional fiscal
year.</text>
</subsection><subsection id="IDb7934468c7354f0994f34f678c19b6df"><enum>(c)</enum><header>Limitation on
amount of grant</header><text>Notwithstanding section 1242(a), a grant under
section 1241 may not be made in an amount exceeding $2,000,000.</text>
</subsection><subsection id="ID9c039a46dd174fd683a773db59404309"><enum>(d)</enum><header>Eligibility</header><text>Except
as provided in section 1242(b)(1)(B)(iii), acquisition of, or eligibility for,
a grant under section 1241(a) shall not preclude a trauma center's eligibility
for the other grants described in such section.</text>
</subsection><subsection id="ID676b5091da4b4597a0c0cb30693cff12"><enum>(e)</enum><header>Funding
distribution</header><text>Of the total amount appropriated for a fiscal year
under section 1245, 70 percent shall be used for substantial uncompensated care
awards under section 1241(a)(1), 20 percent shall be used for core mission
awards under section 1241(a)(2), and 10 percent shall be used for emergency
awards under section 1241(a)(3).</text>
</subsection><subsection id="ID867d66a07a264f0aa61799a9f9e59a44"><enum>(f)</enum><header>Minimum
allowance</header><text>Notwithstanding subsection (e), if the amount
appropriated for a fiscal year under section 1245 is less than $25,000,000, all
available funding for such fiscal year shall be utilized for substantial
uncompensated care awards under section 1241(a)(1).</text>
</subsection><subsection id="idDAE7DD204A2D460FB441A24228CC8E7C"><enum>(g)</enum><header>Substantial
uncompensated care award distribution and proportional
share</header><text>Notwithstanding section 1242(a), of the amount appropriated
for substantial uncompensated care grants for a fiscal year, the Secretary
shall—</text>
<paragraph id="id3505DC23AC9C4069A936EFDE948E27D4"><enum>(1)</enum><text>make
available—</text>
<subparagraph id="id0153D892677E415D887A57D6D037E943"><enum>(A)</enum><text>50 percent of
such funds for category A trauma center grantees;</text>
</subparagraph><subparagraph id="id02C2AC2ED14A488B876D3EF34003DEFD"><enum>(B)</enum><text>35 percent of
such funds for category B trauma center grantees; and</text>
</subparagraph><subparagraph id="idFCD79C4390554CC6B0EEFA2B59224422"><enum>(C)</enum><text>15 percent of
such funds for category C trauma center grantees; and</text>
</subparagraph></paragraph><paragraph id="id40DA13086794418CB66E0781E77A1F93"><enum>(2)</enum><text>provide available
funds within each category in a manner proportional to the award basis
specified in section 1242(a)(2) to each eligible trauma center.</text>
</paragraph></subsection><subsection id="idF53594A8D76A455EA5E312FD765A2F4E"><enum>(h)</enum><header>Report</header><text>Beginning
2 years after the date of enactment of the <short-title>National Trauma Center Stabilization Act of
2009</short-title>, and every two years thereafter, the Secretary shall
biennially—</text>
<paragraph id="id99385E3C2DF6484CBDAAE79C63ACD355"><enum>(1)</enum><text>report to
Congress on the status of the grants made pursuant to section 1241; and</text>
</paragraph><paragraph id="id49BE1EDF70BD49C2A84470524A57452B"><enum>(2)</enum><text>evaluate and
report to Congress on the overall financial stability of trauma centers in the
United
States.</text>
</paragraph></subsection><after-quoted-block>.</after-quoted-block></quoted-block>
</section><section id="id01C1C411BA6442D59D2A732A215DB780"><enum>105.</enum><header>Authorization
of appropriations</header><text display-inline="no-display-inline">Section 1245
of the Public Health Service Act (42 U.S.C. 300d–45) is amended to read as
follows:</text>
<quoted-block display-inline="no-display-inline" id="id346B86F4C4D94B559CD6C0BCCA614EE4" style="OLC">
<section id="id0500D640710E44C398B63679CF1535C7"><enum>1245.</enum><header>Authorization
of appropriations</header><text display-inline="no-display-inline">For the
purpose of carrying out this part, there are authorized to be appropriated
$100,000,000 for fiscal year 2009, and such sums as may be necessary for each
of fiscal years 2010 through 2015. Such authorization of appropriations is in
addition to any other authorization of appropriations or amounts that are
available for such
purpose.</text>
</section><after-quoted-block>.</after-quoted-block></quoted-block>
</section><section id="id1DF3B89F8B804E799E8EBB4547393181"><enum>106.</enum><header>Definition</header><text display-inline="no-display-inline">Part D of title XII of the Public Health
Service Act (42 U.S.C. 300d–41 et seq.) is amended by adding at the end the
following:</text>
<quoted-block display-inline="no-display-inline" id="id48ADB41D556C431981B43BD708D329A7" style="OLC">
<section id="idDB6E50ACFD434C1293D9C94D05D8F654"><enum>1246.</enum><header>Definition</header><text display-inline="no-display-inline">In this part, the term <term>uncompensated
care costs</term> means unreimbursed costs from serving self-pay, charity, or
Medicaid patients, without regard to payment under section 1923 of the Social
Security Act, all of which are attributable to emergency care and trauma care,
including costs related to subsequent inpatient admissions to the
hospital.</text>
</section><after-quoted-block>.</after-quoted-block></quoted-block>
</section><enum>II</enum><header>Trauma service
availability</header>
<section id="id73AB7AE792584940A351BE866C89F68E"><enum>201.</enum><header>Establishment
of grant program</header><text display-inline="no-display-inline">Title XII of
the Public Health Service Act (42 U.S.C. 300d et seq.) is amended by adding at
the end the following:</text>
<quoted-block display-inline="no-display-inline" id="idE6725AEF5B9043FCB10BD2C96E5F258E" style="OLC">
<part id="id64D59A0735D744E2A18505A3F95AAAAC"><enum>H</enum><header>Trauma service
availability</header>
<section id="id06247C33EA4B40E0BAA8002939F2CC36"><enum>1281.</enum><header>Grants to
States</header>
<subsection id="id6D068FA1EC0F424F95EA74AFE132311F"><enum>(a)</enum><header>Establishment</header><text>To
ensure universal access to trauma care services provided by trauma centers and
trauma-related physician specialties, the Secretary shall provide funding to
States to enable such States to award grants to eligible entities for the
purposes contained in this section.</text>
</subsection><subsection id="ID04c4292c7dfd4273acef1ec7257b961a"><enum>(b)</enum><header>Awarding of
grants by States</header><text>Each State may award grants to eligible entities
within the State to—</text>
<paragraph id="idDC291CA01B904649943B8812F04D870B"><enum>(1)</enum><text>improve the
availability of trauma services in underserved areas;</text>
</paragraph><paragraph id="id2F6E467095B946369CE1C49F73C9F9E7"><enum>(2)</enum><text>address trauma
center over-crowding;</text>
</paragraph><paragraph id="idB32D4621FAEC4CA3816F6F356C18AA85"><enum>(3)</enum><text>enhance trauma
surge capacity;</text>
</paragraph><paragraph id="id9261870430D24FAA8203B2F40CFB6FBB"><enum>(4)</enum><text>address shortages
of trauma surgeons and certain other trauma related physician subspecialties,
including providing reimbursement for the unreimbursed costs to trauma centers
for trauma-related physician compensation to ensure the availability of such
physicians to protect against trauma center closures or downgrades; and</text>
</paragraph><paragraph id="idFB3780EB378742F382A46C88AB3CF6A7"><enum>(5)</enum><text>improve trauma
service coordination and the appropriate transport of trauma patients to trauma
centers.</text>
</paragraph></subsection><subsection id="id2637E3955C304264A4DD2F467476BA40"><enum>(c)</enum><header>Eligibility</header>
<paragraph id="idA930D582CEBD45E89C320DC3D17CD618"><enum>(1)</enum><header>In
general</header><text>To be eligible to receive a grant under subsection (b) an
entity shall—</text>
<subparagraph id="IDdcfafd1a6b2743dc8133289cbb022c27"><enum>(A)</enum><text>be—</text>
<clause id="idA812AA0C7DFD4CE9A02B61250EDD4928"><enum>(i)</enum><text>a
public or non-profit trauma center that meets that requirements of paragraphs
(1), (2), and (5) of section 1241(b);</text>
</clause><clause id="idFF2AD60542C64E07B4D9C9A2BBB44967"><enum>(ii)</enum><text>a safety net
public or nonprofit trauma center that meets the requirements of paragraphs (1)
through (5) of section 1241(b) for the purposes of grants to carry out
activities described in paragraphs (1) and (2) of subsection (d);</text>
</clause><clause id="ID5511cd8c29e64bb2b36eb1e3921b3bdb"><enum>(iii)</enum><text>a consortium of
public or non-profit trauma centers; or</text>
</clause><clause id="ID49ad9a60564e40c28a88a0f4fbc4b5c8"><enum>(iv)</enum><text>a hospital that
seeks to establish new trauma services in underserved areas (as defined by the
State); and</text>
</clause></subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="id89ECCC4A69A44A2890771EF968E2B144"><enum>(B)</enum><text>submit to the
State an application at such time, in such manner, and containing such
information as the State may require.</text>
</subparagraph></paragraph><paragraph commented="no" display-inline="no-display-inline" id="id68AA51F880C04DB1A1DC36B0EA2C5C3A"><enum>(2)</enum><header>Limitation</header><text>A
State shall utilize at least 40 percent of the amount available to the State
under this part for a fiscal year to award grants to entities described in
paragraph (1)(A)(ii).</text>
</paragraph></subsection><subsection id="id246C9291CDF041949C356762142D19A5"><enum>(d)</enum><header>Use of
funds</header><text>The recipient of a grant under subsection (b) shall carry
out one or more of the following activities consistent with subsection
(b):</text>
<paragraph id="ID64a99c79d4bf4f90a3152c5743d59eba"><enum>(1)</enum><text>Providing safety
net trauma centers with funding to support physician compensation in
trauma-related physician specialties where shortages exist in the region
involved.</text>
</paragraph><paragraph id="IDc334316829a9477c9f8ba9c1f71caf1c"><enum>(2)</enum><text>Providing for
individual safety net trauma center fiscal stability and costs related to
24-hour a day, 7 days a week, service availability with priority provided to
safety net trauma centers located in urban, border, and isolated rural
areas.</text>
</paragraph><paragraph id="IDd87c707e15774936975aed64ea12a87e"><enum>(3)</enum><text>Activities to
reduce trauma center overcrowding.</text>
</paragraph><paragraph id="ID6d37c4fd67e54455a34031d40548c08d"><enum>(4)</enum><text>Establishing new
trauma services in underserved areas.</text>
</paragraph><paragraph id="ID8ac468ca6155419f9c34864aee282ae9"><enum>(5)</enum><text>Enhancing
regional systemic coordination of trauma service availability.</text>
</paragraph><paragraph id="ID9453705aac8c4498b63e0107dab63d8a"><enum>(6)</enum><text>Making capital
improvements to enhance access and expedite trauma care, including providing
helipads and associated safety infrastructure.</text>
</paragraph><paragraph id="IDb98603f67c5b46a9a081e46f38656fb6"><enum>(7)</enum><text>Enhancing
regional trauma surge capacity.</text>
</paragraph><paragraph id="id67466F19B8144B60A000202C313B5CCF"><enum>(8)</enum><text>Ensuring
expedient transport by ground or air to the appropriate trauma center.</text>
</paragraph></subsection><subsection id="id736F64FEE7BC4A48AAF4D1A5546238B4"><enum>(e)</enum><header>Limitation</header><text>A
State may use not to exceed 20 percent of the amount available to the State
under this part for a fiscal year for administrative and systemic costs of the
State in awarding grants, including coordination with other States to recognize
existing or otherwise appropriate patient transfer patterns that may exist
beyond State boundaries while remaining consistent with the State trauma and
emergency medical service systems of each State.</text>
</subsection><subsection id="IDad5073166b3a46a0a2c0390a5c6a780e"><enum>(f)</enum><header>Distribution of
funds</header>
<paragraph id="idE56804349A8C47DBBCDD1C47EB6A8432"><enum>(1)</enum><header>Population</header><text>Except
as provided in paragraph (2), from the amount appropriated for each fiscal year
to carry out this part, the Secretary shall distribute to each State an amount
that bears the same ratio to such appropriated amount as the population of the
State involved (as reported in the most recent decennial census) bears to the
total population of the United State (as reported in the most recent decennial
census).</text>
</paragraph><paragraph id="id499EF7A8AEE6403493A953C6CEAA5E74"><enum>(2)</enum><header>Minimum
amount</header><text>Notwithstanding paragraph (1), a State shall at a minimum
receive an amount for a fiscal year that is not less than 1 percent of the
amount appropriated for such fiscal year.</text>
</paragraph></subsection></section><section id="IDac251a45ddfe48a49c2d31b88b504d47"><enum>1282.</enum><header>Authorization
of appropriations</header><text display-inline="no-display-inline">For the
purpose of carrying out this part, there is authorized to be appropriated
$100,000,000 for each of fiscal years 2010 through
2015.</text>
</section></part><after-quoted-block>.</after-quoted-block></quoted-block>
</section>