[Congressional Record Volume 142, Number 100 (Tuesday, July 9, 1996)]
[House]
[Pages H7126-H7128]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




PROVIDING EXPANDED STUDIES AND INNOVATIVE PROGRAMS FOR TRAUMATIC BRAIN 
                                 INJURY

  Mr. GREENWOOD. Mr. Speaker, I move to suspend the rules and pass the 
bill (H.R. 248) to amend the Public Health Service Act to provide for 
the conduct of expanded studies and the establishment of innovative 
programs with respect to traumatic brain injury, and for other 
purposes, as amended.
  The Clerk read as follows:

                                H.R. 248

       Be it enacted by the Senate and House of Representatives of 
     the United States of America in Congress assembled,

     SECTION 1. PROGRAMS OF CENTERS FOR DISEASE CONTROL AND 
                   PREVENTION.

       Part J of title III of the Public Health Service Act (42 
     U.S.C. 280b et seq.) is amended by inserting after section 
     393 the following section:


                 ``prevention of traumatic brain injury

       ``Sec. 393A. (a) In General.--The Secretary, acting through 
     the Director of the Centers for Disease Control and 
     Prevention, may carry out projects to reduce the incidence of 
     traumatic brain injury. Such projects may be carried out by 
     the Secretary directly or through awards of grants or 
     contracts to public or nonprofit private entities. The 
     Secretary may directly or through such awards provide 
     technical assistance with respect to the planning, 
     development, and operation of such projects.
       ``(b) Certain Activities.--Activities under subsection (a) 
     may include--
       ``(1) the conduct of research into identifying effective 
     strategies for the prevention of traumatic brain injury; and
       ``(2) the implementation of public information and 
     education programs for the prevention of such injury and for 
     broadening the awareness of the public concerning the public 
     health consequences of such injury.
       ``(c) Coordination of Activities.--The Secretary shall 
     ensure that activities under this section are coordinated as 
     appropriate with other agencies of the Public Health Service 
     that carry out activities regarding traumatic brain injury.
       ``(d) Definition.--For purposes of this section, the term 
     `traumatic brain injury' means an acquired injury to the 
     brain. Such term does not include brain dysfunction caused by 
     congenital or degenerative disorders, nor birth trauma, but 
     may include brain injuries caused by anoxia due to near 
     drowning. The Secretary may revise the definition of such 
     term as the Secretary determines necessary.''.

     SEC. 2. PROGRAMS OF NATIONAL INSTITUTES OF HEALTH.

       Section 1261 of the Public Health Service Act (42 U.S.C. 
     300d-61) is amended--
       (1) in subsection (d)--
       (A) in paragraph (2), by striking ``and'' after the 
     semicolon at the end;
       (B) in paragraph (3), by striking the period and inserting 
     ``; and''; and
       (C) by adding at the end the following paragraph:
       ``(4) the authority to make awards of grants or contracts 
     to public or nonprofit private entities for the conduct of 
     basic and applied research regarding traumatic brain injury, 
     which research may include--
       ``(A) the development of new methods and modalities for the 
     more effective diagnosis, measurement of degree of injury, 
     post-injury monitoring and prognostic assessment of head 
     injury for acute, subacute and later phases of care;
       ``(B) the development, modification and evaluation of 
     therapies that retard, prevent or reverse brain damage after 
     acute head injury, that arrest further deterioration 
     following injury and that provide the restitution of function 
     for individuals with long-term injuries;
       ``(C) the development of research on a continuum of care 
     from acute care through rehabilitation, designed, to the 
     extent practicable, to integrate rehabilitation and long-term 
     outcome evaluation with acute care research; and
       ``(D) the development of programs that increase the 
     participation of academic centers of excellence in head 
     injury treatment and rehabilitation research and training.''; 
     and
       (2) in subsection (h), by adding at the end the following 
     paragraph:
       ``(4) The term `traumatic brain injury' means an acquired 
     injury to the brain. Such term does not include brain 
     dysfunction caused by congenital or degenerative disorders, 
     nor birth trauma, but may include brain injuries caused by 
     anoxia due to near drowning. The Secretary may revise the 
     definition of such term as the Secretary determines 
     necessary.''.

     SEC. 3. PROGRAMS OF HEALTH RESOURCES AND SERVICES 
                   ADMINISTRATION.

       Part E of title XII of the Public Health Service Act (42 
     U.S.C. 300d-51 et seq.) is amended by adding at the end the 
     following section:

     ``SEC. 1252. STATE GRANTS FOR DEMONSTRATION PROJECTS 
                   REGARDING TRAUMATIC BRAIN INJURY.

       ``(a) In General.--The Secretary, acting through the 
     Administrator of the Health Resources and Services 
     Administration, may make grants to States for the purpose of 
     carrying out demonstration projects to improve access to 
     health and other services regarding traumatic brain injury.
       ``(b) State Advisory Board.--
       ``(1) In general.--The Secretary may make a grant under 
     subsection (a) only if the State involved agrees to establish 
     an advisory board within the appropriate health department of 
     the State or within another department as designated by the 
     chief executive officer of the State.
       ``(2) Functions.--An advisory board established under 
     paragraph (1) shall advise and make recommendations to the 
     State on ways to improve services coordination regarding 
     traumatic brain injury. Such advisory boards shall encourage 
     citizen participation through the establishment of public 
     hearings and other types of community outreach programs. In 
     developing recommendations under this paragraph, such boards 
     shall consult with Federal, State, and local governmental 
     agencies and with citizens groups and other private entities.
       ``(3) Composition.--An advisory board established under 
     paragraph (1) shall be composed of--
       ``(A) representatives of--
       ``(i) the corresponding State agencies involved;
       ``(ii) public and nonprofit private health related 
     organizations;
       ``(iii) other disability advisory or planning groups within 
     the State;
       ``(iv) members of an organization or foundation 
     representing traumatic brain injury survivors in that State; 
     and
       ``(v) injury control programs at the State or local level 
     if such programs exist; and
       ``(B) a substantial number of individuals who are survivors 
     of traumatic brain injury, or the family members of such 
     individuals.
       ``(c) Matching Funds.--
       ``(1) In general.--With respect to the costs to be incurred 
     by a State in carrying out the purpose described in 
     subsection (a), the Secretary may make a grant under such 
     subsection only if the State agrees to make available, in 
     cash, non-Federal contributions toward such costs in an 
     amount that is not less than $1 for each $2 of Federal funds 
     provided under the grant.
       ``(2) Determination of amount contributed.--In determining 
     the amount of non-Federal contributions in cash that a State 
     has provided pursuant to paragraph (1), the Secretary may not 
     include any amounts provided to the State by the Federal 
     Government.
       ``(d) Application for Grant.--The Secretary may make a 
     grant under subsection (a) only if an application for the 
     grant is submitted to the Secretary and the application is in 
     such form, is made in such manner, and contains such 
     agreements, assurances, and information as the Secretary 
     determines to be necessary to carry out this section.
       ``(e) Coordination of Activities.--The Secretary shall 
     ensure that activities under this section are coordinated as 
     appropriate with other agencies of the Public Health Service 
     that carry out activities regarding traumatic brain injury.
       ``(f) Report.--Not later than 2 years after the date of the 
     enactment of this section, the Secretary shall submit to the 
     Committee on Commerce of the House of Representatives, and to 
     the Committee on Labor and Human Resources of the Senate, a 
     report describing the findings and results of the programs 
     established under this section, including measures of 
     outcomes and consumer and surrogate satisfaction.
       ``(g) Definition.--For purposes of this section, the term 
     `traumatic brain injury' means an acquired injury to the 
     brain. Such term does not include brain dysfunction caused by 
     congenital or degenerative disorders, nor birth trauma, but 
     may include brain injuries caused by anoxia due to near 
     drowning. The Secretary may revise the definition of such 
     term as the Secretary determines necessary.
       ``(h) Authorization of Appropriations.--For the purpose of 
     carrying out this section, there is authorized to be 
     appropriated $5,000,000 for each of the fiscal years 1997 
     through 1999.''.

     SEC. 4. STUDY; CONSENSUS CONFERENCE.

       (a) Study.--
       (1) In general.--The Secretary of Health and Human Services 
     (in this section referred to as the ``Secretary''), acting 
     through the appropriate agencies of the Public Health 
     Service, shall conduct a study for the purpose of carrying 
     out the following with respect to traumatic brain injury:
       (A) In collaboration with appropriate State and local 
     health-related agencies--
       (i) determine the incidence and prevalence of traumatic 
     brain injury; and
       (ii) develop a uniform reporting system under which States 
     report incidents of traumatic brain injury, if the Secretary 
     determines that such a system is appropriate.
       (B) Identify common therapeutic interventions which are 
     used for the rehabilitation of individuals with such 
     injuries, and shall, subject to the availability of 
     information, include an analysis of--
       (i) the effectiveness of each such intervention in 
     improving the functioning of individuals with brain injuries;
       (ii) the comparative effectiveness of interventions 
     employed in the course of rehabilitation of individuals with 
     brain injuries to achieve the same or similar clinical 
     outcome; and
       (iii) the adequacy of existing measures of outcomes and 
     knowledge of factors influencing differential outcomes.
       (C) Develop practice guidelines for the rehabilitation of 
     traumatic brain injury at such time as appropriate scientific 
     research becomes available.
       (2) Dates certain for reports.--
       (A) Not later than 18 months after the date of the 
     enactment of this Act, the Secretary shall submit to the 
     Committee on Commerce of the House of Representatives, and to 
     the Committee on Labor and Human Resources of the Senate, a 
     report describing the findings made as a result of carrying 
     out paragraph (1)(A).
       (B) Not later than 3 years after the date of the enactment 
     of this Act, the Secretary shall submit to the Committees 
     specified in subparagraph

[[Page H7127]]

     (A) a report describing the findings made as a result of 
     carrying out subparagraphs (B) and (C) of paragraph (1).
       (b) Consensus Conference.--The Secretary, acting through 
     the Director of the National Center for Medical 
     Rehabilitation Research within the National Institute for 
     Child Health and Human Development, shall conduct a national 
     consensus conference on managing traumatic brain injury and 
     related rehabilitation concerns.
       (c) Definition.--For purposes of this section, the term 
     ``traumatic brain injury'' means an acquired injury to the 
     brain. Such term does not include brain dysfunction caused by 
     congenital or degenerative disorders, nor birth trauma, but 
     may include brain injuries caused by anoxia due to near 
     drowning. The Secretary may revise the definition of such 
     term as the Secretary determines necessary.
       (d) Authorizations of Appropriations.--For the purpose of 
     carrying out subsection (a)(1)(A), there is authorized to be 
     appropriated $3,000,000 for each of the fiscal years 1997 
     through 1999. For the purpose of carrying out the other 
     provisions of this section, there is authorized to be 
     appropriated an aggregate $500,000 for the fiscal years 1997 
     through 1999. Amounts appropriated for such other provisions 
     remain available until expended.

     SEC. 5. TECHNICAL AMENDMENTS.

       Title XXVI of the Public Health Service Act (42 U.S.C. 
     300ff-11 et seq.), as amended by Public Law 104-146 (the Ryan 
     White CARE Act Amendments of 1996), is amended--
       (1) in section 2626--
       (A) in subsection (d), in the first sentence, by striking 
     ``(1) through (5)'' and inserting ``(1) through (4)''; and
       (B) in subsection (f), in the matter preceding paragraph 
     (1), by striking ``(1) through (5)'' and inserting ``(1) 
     through (4)''; and
       (2) in section 2692--
       (A) in subsection (a)(1)(A)--
       (i) by striking ``title XXVI programs'' and inserting 
     ``programs under this title''; and
       (ii) by striking ``infection and''; and
       (B) by striking subsection (c) and all that follows and 
     inserting the following:
       ``(c) Authorization of Appropriations.--
       ``(1) Schools; centers.--For the purpose of grants under 
     subsection (a), there are authorized to be appropriated such 
     sums as may be necessary for each of the fiscal years 1996 
     through 2000.
       ``(2) Dental schools.--For the purpose of grants under 
     subsection (b), there are authorized to be appropriated such 
     sums as may be necessary for each of the fiscal years 1996 
     through 2000.''.

  The SPEAKER pro tempore. Pursuant to the rule, the gentleman from 
Pennsylvania [Mr. Greenwood] and the gentleman from New Jersey [Mr. 
Pallone] each will control 20 minutes.
  The Chair recognizes the gentleman from Pennsylvania [Mr. Greenwood].
  Mr. GREENWOOD. Mr. Speaker, I yield myself such time as I may 
consume.
  Mr. Speaker, I am pleased to report that the legislation before us is 
the result of a strong bipartisan effort in both Chambers over the past 
3 years. I especially want to thank chairmen Bliley and Bilirakis, and 
Congressmen Dingell, Waxman, and Pallone for their willingness to work 
with me to secure enactment of this important bill. The beneficiaries 
of this cooperation are the millions of individuals who sustain severe 
brain trauma each year.
  Traumatic brain injury has become the No. 1 killer and cause of 
disability of young people in this country. We now have enhanced 
abilities to respond rapidly to the scene of vehicle accidents and 
other mishaps with highly trained personnel to airlift victims to 
state-of-art trauma centers and provide them with miraculous lifesaving 
procedures during the critical post injury ``golden hour.'' As a 
result, thousands of our sons and daughters, and fathers and mothers 
have survived serious brain injury and now must be cared for humanely.
  Our challenge now is to develop in-home residential and long-term-
care facilities where those recovering from head injury can receive 
physical therapy, occupational therapy and cognitive rehabilitation so 
that, whenever possible, they may resume their places at home with 
their loved ones.
  In 1989, the Department of Health and Human Services issued an 
interagency task force report that recommended development of a 
national strategy to address prevention of traumatic brain injuries, 
and to provide for acute and long-term care and community reintegration 
of traumatic brain injury survivors. This legislation does just that.
  The bill would authorize $3 million for each of the fiscal years 1997 
through 1999 for the Centers for Disease Control and Prevention [CDC] 
to carry out projects to prevent traumatic brain injury; authorize the 
National Institutes of Health [NIH] to conduct research into the 
prevention and treatment of traumatic brain injury; and authorize 
grants to States equal to $5 million for each of the fiscal years 1997 
through 1999 for the establishment of demonstration projects to improve 
access to health and others services regarding traumatic brain injury. 
States are required to contribute $1 for every $2 of Federal funds.
  Require the Secretary of Health and Human Services to conduct a study 
to determine the incidence and prevalence of traumatic brain injury; 
develop a uniform reporting system concerning the reporting of 
incidents of such injuries; and identify common therapeutic 
interventions used for the rehabilitation of injured individuals; and 
require the Secretary of Health and Human Services to conduct a 
consensus conference on managing traumatic brain injury and related 
rehabilitation concerns. An aggregate of $500,000 is authorized for 
these purposes.
  Enactment of this legislation is an important step toward preventing, 
understanding, and effectively beating these devastating brain 
injuries. I urge my colleagues to support this important legislation.

                              {time}  1430

  Mr. GREENWOOD. Mr. Speaker, I reserve the balance of my time.
  Mr. PALLONE. Mr. Speaker, I yield myself such time as I may consume.
  Mr. Speaker, I rise in support of this legislation. H.R. 248 
authorizes funds to develop and create and operate a spectrum of 
critically important programs to prevent and treat traumatic brain 
injury and to educate the public, health care providers, and the 
patients about the nature of these injuries and the most appropriate 
ways to deal with them.
  Traumatic brain injury is the primary cause of death and disability 
among young people in the United States. By anyone's definition, these 
injuries have reached epidemic proportions, affecting nearly 2 million 
Americans each year, with severe and devastating consequences. Five 
hundred thousand are injured so severely that they must be 
hospitalized; 90,000 suffer irreversible loss of function; 50,000 
people, many in the prime of their lives, die as a result of an injury 
or blow to the head from a fall, a violent crime, or a motor vehicle or 
sports accident. The cost to care for people with brain injuries is 
astronomical, over $98 billion a year. But this is not an epidemic that 
we have read about in novels or seen in movies. It is a silent 
epidemic, quietly claiming its young victims without the sort of public 
alarm that would accompany any infectious disease outbreak of this 
magnitude.
  People living with the consequences of severe brain injury require 
health care, rehabilitative care and social services that differ 
substantially from services needed by individuals with other kinds of 
disabilities. Ensuring that such specialized services are available 
requires that health care providers and others recognize and understand 
these injuries as unique, learn how to take appropriate action to 
minimize the damage from head injury, and take aggressive approaches to 
preventing such injuries.
  My colleague, and the prime sponsor of this bill, the gentleman from 
Pennsylvania [Mr. Greenwood], basically went through how this bill 
authorizes an excellent approach toward accomplishing the goals that he 
mentioned that we are trying to achieve here. The bill authorizes the 
Centers for Disease Control and Prevention carry out programs to 
identify strategies for preventing traumatic brain injury. In addition, 
the NIH [National Institutes of Health] is authorized to award grant 
funds for various purposes relating to traumatic brain injury.
  The bill also authorizes the Health Resources and Services 
Administration to award grants to States. And, finally, H.R. 248 
requires that the Secretary determine the incidence and prevalence of 
traumatic brain injury and develop a uniform reporting system; analyze 
common therapies and conduct a consensus conference that brings 
together all interested parties to discuss treatment, management, and 
rehabilitation.
  Mr. Speaker, this bill goes a long way toward shedding critical light 
on the darkness of the silent epidemic of traumatic brain injury. The 
House has passed similar legislation in the past, only to see it 
encumbered by unrelated

[[Page H7128]]

provisions and bogged down in complicated processes. Today, we have 
another chance to do the right thing.
  Mr. Speaker, I know that the gentleman from Pennsylvania [Mr. 
Greenwood] has been out there trying to urge that we move this bill as 
a freestanding measure and get it to the President as quickly as 
possible, and I know that he joins with me and many others in hoping 
that this time the legislative journey will have its final destination 
on the President's desk.
  The millions of people whose lives are touched each day by 
devastating tragedies that result from traumatic brain injuries need to 
know that we care about them and we will try to help them.
  Mr. Speaker, I reserve the balance of my time.
  Mr. GREENWOOD. Mr. Speaker, I have no further requests for time, and 
I yield back the balance of my time.
  Mr. PALLONE. Mr. Speaker, I yield back the balance of my time.
  Mr. SPEAKER pro tempore. The question is on the motion offered by the 
gentleman from Pennsylvania [Mr. Greenwood] that the House suspend the 
rules and pass the bill, H.R. 249, as amended.
  The question was taken; and (two-thirds having voted in favor 
thereof) the rules were suspended and the bill, as amended, was passed.
  A motion to reconsider was laid on the table.

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