[Congressional Record Volume 153, Number 39 (Wednesday, March 7, 2007)]
[Senate]
[Pages S2801-S2803]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. HATCH (for himself and Mr. Kennedy):
  S. 793. A bill to provide for the expansion and improvement of 
traumatic brain injury programs; to the Committee on Health, Education, 
Labor, and Pensions.
  Mr. HATCH. Mr. President, I rise today to introduce legislation to 
reauthorize the Traumatic Brain Injury Act. It is my pleasure to be 
joined in this effort by the Chairman of the Senate Health, Education, 
Labor and Pension Committee, Senator Ted Kennedy, with whom I worked on 
the original legislation over 10 years ago.
  Sustaining a traumatic brain injury--or TBI--can be both catastrophic 
and devastating. The financial and emotional costs to the individual, 
family, and community are enormous. Traumatic brain injuries contribute 
to a substantial number of deaths and cases of permanent disability 
annually.
  Individuals with TBI and their families are often faced with 
challenges, such as improper diagnosis, inability to access support or 
rehabilitation services, institutional segregation, unemployment, and 
being forced to navigate complicated and cumbersome service and support 
systems.
  Of the 1.4 million who sustain a TBI each year in the United States: 
50,000 die; 235,000 are hospitalized; and 1.1 million are treated and 
released from an emergency department. Brain injuries are the most 
frequent reasons for visits to physicians and emergency rooms.
  These statistics are more revealing when one considers that every 16 
seconds someone in the U.S. sustains a head injury; and every 12 
minutes, one of these people will die and another will become 
permanently disabled. Of those who survive, each year, an estimated 
80,000 to 90,000 people experience the onset of long-term disability 
associated with a TBI. An additional 2,000 will exist in a persistent 
vegetative state.
  Even more startling is the fact that brain injury kills more 
Americans under the age of 34 than all other causes combined and has 
claimed more lives since the turn of the century than all United States 
wars combined.
  Recent publicity about brain injuries Americans have sustained in 
Iraq points out that TBI is an everyday threat to our servicemen and 
servicewomen--68 percent of war veterans are returning home with 
sustained brain injuries. According to the Defense and Veterans Brain 
Injury Center, which serves active duty military, their dependents and 
veterans with TBI, traumatic brain injury is one of the leading causes 
of death and disability on today's battlefield. While not specifically 
addressed by this bill, the Federal TBI program helps to provide 
resources that supplement the networks which serve our returning 
soldiers.
  The distress of TBI is not limited to diagnosis. A survivor of a 
severe brain injury typically faces 5 to 10 years of intensive services 
and estimated lifetime costs can exceed $4 million. Direct medical 
costs and indirect costs such as lost productivity of TBI totaled an 
estimated $60 billion in the United States in 2000.
  To recognize the large number of individuals and families struggling 
to access appropriate and community-based services, Senator Kennedy and 
I wrote the TBI Act of 1996, PL 104-166.
  The TBI Act of 1996 launched an effort to conduct expanded studies 
and to establish innovative programs for TBI. It gave the Health 
Resources and Services Administration (HRSA) authority to establish a 
grant program for States to assist it in addressing the needs of 
individuals with TBI and their families. It also delegated 
responsibilities in the areas of research, prevention, and surveillance 
to the National Institutes of Health (NIH) and the Centers for Disease 
Control and Prevention (CDC), respectively.
  Title XIII of the Children's Health Act of 2000, PL 106-310, 
reauthorized the programs of the TBI Act of 1996. This reauthorization 
also added a provision on protection and advocacy, P&A, services for 
individuals with TBI and their families by authorizing HRSA to make 
grants to State P&A Systems.
  The Traumatic Brain Injury Act is the only Federal legislation that 
specifically addresses issues faced by 5.3 million American children 
and adults who live with a long-term disability as a result of 
traumatic brain injury. Reauthorization of the Traumatic Brain Injury 
Act will provide for the continuation of research, not only for the 
treatment of TBI, but also for prevention and awareness programs which 
will help decrease the occurrence of traumatic brain injury and improve 
the long-term outcome.
  This legislation authorizes the Health Resources and Services 
Administration, HRSA, to make grants for projects of national 
significance that improve individual and family access to service 
systems; assist States in developing service capacity; improve 
monitoring and evaluation of rehabilitation services and supports; and 
address emerging needs of servicemen and women, veterans, and 
individuals and families who have experienced

[[Page S2802]]

brain injury through service delivery demonstration projects.
  This bill also authorizes HRSA to include the American Indian 
Consortium as an eligible recipient of competitive grants awarded to 
States, Territories, and the District of Columbia to develop 
comprehensive system of services and supports nationwide.
  Furthermore, this bill instructs HRSA and the Administration on 
Developmental Disabilities to coordinate data collection regarding 
protection and advocacy services.
  Also funded by the TBI program, the CDC supports multiple projects 
and programs, including those that monitor TBI, link people with TBI to 
information about services, and prevent TBI-related disabilities. These 
projects comprise initiatives such as generating national estimates for 
TBI deaths, hospitalizations, and emergency department visits; planning 
the future of TBI registries and data systems; and educating health 
care professionals about TBI. In addition, the CDC funds TBI research 
in various academic institutions to investigate TBI in children and 
adolescents.
  This year, Congress has an opportunity to strengthen the TBI Act by 
authorizing the Centers for Disease Control and Prevention, CDC, to 
determine the incidence and prevalence of traumatic brain injury in the 
general population of the United States, including all age groups and 
persons in institutional settings such as nursing homes, correctional 
facilities, psychiatric hospitals, child care facilities, and 
residential institutes for people with developmental disabilities.
  Brain injury is a complex issue and there is still much unknown. With 
Federal funds provided within the TBI program, researchers at the NIH 
are studying many issues related to the special cognitive and 
communication problems experienced by individuals who have traumatic 
brain injuries. Scientists are designing new evaluation tools to assess 
the special problems that children who have suffered traumatic brain 
injuries encounter. Because the brain of a child is vastly different 
from the brain of an adult, scientists are also examining the effects 
of various treatment methods that have been developed specifically for 
children. In addition, research is examining the effects of some 
medications on the recovery of speech, language, and cognitive 
abilities following traumatic brain injury. Reauthorization of the TBI 
program will enable this important research to continue and expand.
  As I have mentioned, there is still a lot of unknown surrounding the 
issue of TBI; however, one aspect is definite, and that is that people 
are never the same after TBI. Not only are their lives forever changed, 
but they must face these changes in a compromised state. The TBI 
program offers balanced and coordinated public policy in brain injury 
prevention, research, education, and community-based services and 
supports for individuals living with traumatic brain injury and their 
families.
  Reauthorization of the Traumatic Brain Injury Act will further 
provide mechanisms for the research, prevention, and treatment of TBI 
and the improvement of the quality of life for those Americans and 
their families who may sustain such a devastating disability. I ask my 
colleagues' support in promptly reauthorizing the Traumatic Brain 
Injury Act.
  I ask unanimous consent that the text of the bill be printed in the 
Record.
  There being no objection, the text of the bill was ordered to be 
printed in the Record, as follows:

                                 S. 793

       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 ``Reauthorization of the 
     Traumatic Brain Injury Act''.

     SEC. 2. CONFORMING AMENDMENTS RELATING TO RESTRUCTURING.

       Part J of title III of the Public Health Service Act (42 
     U.S.C. 280b et seq.) is amended--
       (1) by redesignating the section 393B (42 U.S.C. 280b-1c) 
     relating to the use of allotments for rape prevention 
     education, as section 393A and moving such section so that it 
     follows section 393;
       (2) by redesignating existing section 393A (42 U.S.C. 280b-
     1b) relating to prevention of traumatic brain injury, as 
     section 393B; and
       (3) by redesignating the section 393B (42 U.S.C. 280b-1d) 
     relating to traumatic brain injury registries, as section 
     393C.

     SEC. 3. TRAUMATIC BRAIN INJURY PROGRAMS OF THE CENTERS FOR 
                   DISEASE CONTROL AND PREVENTION.

       (a) Prevention of Traumatic Brain Injury.--Clause (ii) of 
     section 393B(b)(3)(A) of the Public Health Service Act, as so 
     redesignated, (42 U.S.C. 280b-1b) is amended by striking 
     ``from hospitals and trauma centers'' and inserting ``from 
     hospitals and emergency departments''.
       (b) National Program for Traumatic Brain Injury 
     Surveillance and Registries.--Section 393C of the Public 
     Health Service Act, as so redesignated, (42 U.S.C. 280b et 
     seq.) is amended--
       (1) in the section heading, by inserting ``SURVEILLANCE 
     AND'' after ``NATIONAL PROGRAM FOR TRAUMATIC BRAIN INJURY'';
       (2) by striking ``(a) IN GENERAL.--''; and
       (3) in the matter preceding paragraph (1), by striking 
     ``may make grants'' and all that follows through ``to collect 
     data concerning--'' and inserting ``may make grants to States 
     or their designees to develop or operate the State's 
     traumatic brain injury surveillance system or registry to 
     determine the incidence and prevalence of traumatic brain 
     injury and related disability, to ensure the uniformity of 
     reporting under such system or registry, to link individuals 
     with traumatic brain injury to services and supports, and to 
     link such individuals with academic institutions to conduct 
     applied research that will support the development of such 
     surveillance systems and registries as may be necessary. A 
     surveillance system or registry under this section shall 
     provide for the collection of data concerning--''.

     SEC. 4. STUDY ON TRAUMATIC BRAIN INJURY.

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

     ``SEC. 393C-1. STUDY ON TRAUMATIC BRAIN INJURY.

       ``(a) Study.--The Secretary, acting through the Director of 
     the Centers for Disease Control and Prevention with respect 
     to paragraph (1) and the Director of the National Institutes 
     of Health with respect to paragraphs (2) and (3), shall 
     conduct a study with respect to traumatic brain injury for 
     the purpose of carrying out the following:
       ``(1) In collaboration with appropriate State and local 
     health-related agencies--
       ``(A) determining the incidence of traumatic brain injury 
     and prevalence of traumatic brain injury related disability 
     and the clinical aspects of the disability in all age groups 
     and racial and ethnic minority groups in the general 
     population of the United States, including institutional 
     settings, such as nursing homes, correctional facilities, 
     psychiatric hospitals, child care facilities, and residential 
     institutes for people with developmental disabilities; and
       ``(B) reporting national trends in traumatic brain injury.
       ``(2) Identifying common therapeutic interventions which 
     are used for the rehabilitation of individuals with such 
     injuries, and, subject to the availability of information, 
     including an analysis of--
       ``(A) the effectiveness of each such intervention in 
     improving the functioning, including return to work or school 
     and community participation, of individuals with brain 
     injuries;
       ``(B) 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
       ``(C) the adequacy of existing measures of outcomes and 
     knowledge of factors influencing differential outcomes.
       ``(3) Identifying interventions and therapies that can 
     prevent or remediate the development of secondary neurologic 
     conditions related to traumatic brain injury.
       ``(4) Developing practice guidelines for the rehabilitation 
     of traumatic brain injury at such time as appropriate 
     scientific research becomes available.
       ``(b) Dates Certain for Reports.--Not later than 3 years 
     after the date of the enactment of the Reauthorization of the 
     Traumatic Brain Injury Act, the Secretary shall submit to the 
     Congress a report describing findings made as a result of 
     carrying out subsection (a).
       ``(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 trauma. 
     The Secretary may revise the definition of such term as the 
     Secretary determines necessary.''.

     SEC. 5. TRAUMATIC BRAIN INJURY PROGRAMS OF THE NATIONAL 
                   INSTITUTES OF HEALTH.

       Section 1261 of the Public Health Service Act (42 U.S.C. 
     300d-61) is amended--
       (1) in subparagraph (D) of subsection (d)(4), by striking 
     ``head brain injury'' and inserting ``brain injury''; and
       (2) in subsection (i), by inserting ``, and such sums as 
     may be necessary for each of fiscal years 2008 through 2011'' 
     before the period at the end.

     SEC. 6. TRAUMATIC BRAIN INJURY PROGRAMS OF THE HEALTH 
                   RESOURCES AND SERVICES ADMINISTRATION.

       (a) State Grants for Demonstration Projects Regarding 
     Traumatic Brain Injury.--Section 1252 of the Public Health 
     Service Act (42 U.S.C. 300d-52) is amended--
       (1) in subsection (a)--

[[Page S2803]]

       (A) by striking ``may make grants to States'' and inserting 
     ``may make grants to States and American Indian consortia''; 
     and
       (B) by striking ``health and other services'' and inserting 
     ``rehabilitation and other services'';
       (2) in subsection (b)--
       (A) in paragraphs (1), (3)(A)(i), (3)(A)(iii), and 
     (3)(A)(iv), by striking the term ``State'' each place such 
     term appears and inserting the term ``State or American 
     Indian consortium''; and
       (B) in paragraph (2), by striking ``recommendations to the 
     State'' and inserting ``recommendations to the State or 
     American Indian consortium'';
       (3) in subsection (c), by striking the term ``State'' each 
     place such term appears and inserting ``State or American 
     Indian consortium'';
       (4) in subsection (e), by striking ``A State that 
     received'' and all that follows through the period and 
     inserting ``A State or American Indian consortium that 
     received a grant under this section prior to the date of the 
     enactment of the Reauthorization of the Traumatic Brain 
     Injury Act may complete the activities funded by the 
     grant.'';
       (5) in subsection (f)--
       (A) in the subsection heading, by inserting ``and American 
     Indian Consortium'' after ``State'';
       (B) in paragraph (1) in the matter preceding subparagraph 
     (A), paragraph (1)(E), paragraph (2)(A), paragraph (2)(B), 
     paragraph (3) in the matter preceding subparagraph (A), 
     paragraph (3)(E), and paragraph (3)(F), by striking the term 
     ``State'' each place such term appears and inserting ``State 
     or American Indian consortium'';
       (C) in clause (ii) of paragraph (1)(A), by striking 
     ``children and other individuals'' and inserting ``children, 
     youth, and adults''; and
       (D) in subsection (h)--
       (i) by striking ``Not later than 2 years after the date of 
     the enactment of this section, the Secretary'' and inserting 
     ``Not less than bi-annually, the Secretary''; and
       (ii) by inserting ``section 1253, and section 1254,'' after 
     ``programs established under this section,'';
       (6) by amending subsection (i) to read as follows:
       ``(i) Definitions.--For purposes of this section:
       ``(1) The terms `American Indian consortium' and `State' 
     have the meanings given to those terms in section 1253.
       ``(2) 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, after consultation with States and other 
     appropriate public or nonprofit private entities.''; and
       (7) in subsection (j), by inserting ``, and such sums as 
     may be necessary for each of the fiscal years 2008 through 
     2011'' before the period.
       (b) State Grants for Protection and Advocacy Services.--
     Section 1253 of the Public Health Service Act (42 U.S.C. 
     300d-53) is amended--
       (1) in subsections (d) and (e), by striking the term 
     ``subsection (i)'' each place such term appears and inserting 
     ``subsection (l)'';
       (2) in subsection (g), by inserting ``each fiscal year not 
     later than October 1,'' before ``the Administrator shall 
     pay'';
       (3) by redesignating subsections (i) and (j) as subsections 
     (l) and (m), respectively;
       (4) by inserting after subsection (h) the following:
       ``(i) Data Collection.--The Administrator of the Health 
     Resources and Services Administration and the Commissioner of 
     the Administration on Developmental Disabilities shall enter 
     into an agreement to coordinate the collection of data by the 
     Administrator and the Commissioner regarding protection and 
     advocacy services.
       ``(j) Training and Technical Assistance.--
       ``(1) Grants.--For any fiscal year for which the amount 
     appropriated to carry out this section is $6,000,000 or 
     greater, the Administrator shall use 2 percent of such amount 
     to make a grant to an eligible national association for 
     providing for training and technical assistance to protection 
     and advocacy systems.
       ``(2) Definition.--In this subsection, the term `eligible 
     national association' means a national association with 
     demonstrated experience in providing training and technical 
     assistance to protection and advocacy systems.
       ``(k) System Authority.--In providing services under this 
     section, a protection and advocacy system shall have the same 
     authorities, including access to records, as such system 
     would have for purposes of providing services under subtitle 
     C of the Developmental Disabilities Assistance and Bill of 
     Rights Act of 2000.''; and
       (5) in subsection (l) (as redesignated by this subsection) 
     by striking ``2005'' and inserting ``2011''.

  Mr. KENNEDY. Mr. President, it's a privilege to join with Senator 
Hatch in introducing legislation to reauthorize the Traumatic Brain 
Injury Act. The reauthorization will expand assistance to the millions 
of adults and children in the nation who are facing serious problems 
because of brain injuries. Its provisions also have a major role in 
meeting the critical needs facing many of our wounded soldiers 
returning home from the wars in Iraq and Afghanistan.
  The numbers tell the story. As of this month, almost 25,000 service 
members have been wounded in Iraq, and approximately two-thirds of the 
injuries include brain injuries. Here at home, an extremely high number 
of children from birth to age 14 experience traumatic brain injuries--
approximately 475,000 a year--and some of the most frequent injuries 
are among children under the age of five.
  Soldiers and children--I cannot think of two more deserving groups of 
people in our nation.
  Reauthorization of the Act is essential to continue the availability 
of federal funds for traumatic brain injury programs. The bill 
reauthorizes grants that assist States, Territories, and the District 
of Columbia in establishing and expanding coordinated systems of 
community-based services and supports for children and adults with such 
injuries. It also extends the ability to apply for these grants to 
American Indian Consortia.
  When Congress approved the Traumatic Brain Injury Act as part of the 
Children's Health Act of 2000, we had the foresight to establish a 
specific provision called the Protection and Advocacy for Individuals 
with Traumatic Brain Injury Program. This program has proved to be 
essential because individuals with traumatic brain injuries have an 
array of needs, including assistance in returning to work, finding a 
place to live, obtaining supports and services such as attendant care 
and assistive technology, and obtaining appropriate mental health, 
substance abuse, and rehabilitation services.
  Often these individuals--especially our returning veterans--must 
remain in extremely expensive institutions far longer than necessary, 
because the community-based supports and services they need are not 
available. Such services can lead both to reduced government 
expenditures and to increased productivity, independence and community 
integration, but the advocates must possess special skills, and their 
work is often time-intensive.
  In addition, our legislation provides funds for CDC programs that 
provide extremely important data gathering and information on injury 
prevention. In a time when both the Administration and Congress are 
searching for programs that provide the right kind of ``bang for the 
federal buck,'' an Institute of Medicine report last March showed that 
the TBI programs work. The programs in the Act were funded for a total 
of only $12 million dollars last year, and yet their benefit is 
obvious. Clearly these programs should be reauthorized and the funding 
should be increased. Although the reauthorization is for ``such sums as 
may be necessary,'' we must do all we can to expand the appropriations 
in the years ahead in order to meet the urgent need for this 
assistance.
  The IOM report called the current TBI programs an ``overall 
success,'' stating that ``there is considerable value in providing . . 
. funding,'' and ``it is worrisome that the modestly budgeted HRSA TBI 
Program continues to be vulnerable to budget cuts.'' As the study 
suggests, this program must be continued and allowed to grow, so that 
each state has the resources necessary to maintain vital services and 
advocacy for the estimated 5.3 million people currently living with 
disabilities resulting from brain injury. When our wounded soldiers 
return to their communities, the services and supports they need must 
be available.
  The nation owes these deserving people--especially our service 
members and our children--the services and advocacy available under 
these critical programs. I urge my colleagues to act quickly on this 
important reauthorization and enact this bipartisan bill as soon as 
possible.
                                 ______