[Congressional Record (Bound Edition), Volume 153 (2007), Part 25]
[Senate]
[Pages 33648-33650]
[From the U.S. Government Publishing Office, www.gpo.gov]




           REAUTHORIZATION OF THE TRAUMATIC BRAIN INJURY ACT

  Mr. REID. Mr. President, I ask unanimous consent that the Senate 
proceed to the immediate consideration of Calendar No. 317, S. 793.
  The PRESIDING OFFICER. The clerk will report the bill by title.
  The legislative clerk read as follows:

       A bill (S. 793) to provide for the expansion and 
     improvement of traumatic brain injury programs.

  There being no objection, the Senate proceeded to consider the bill, 
which had been reported from the Committee on Health, Education, Labor, 
and Pensions, with an amendment to strike all after the enacting clause 
and insert in lieu thereof the following:

     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''; 
     and
       (2) in subsection (a), 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--''.
       (c) Report.--Section 393C of the Public Health Service Act 
     (as so redesignated) is amended by adding at the end the 
     following:
       ``(b) Not later than 18 months after the date of enactment 
     of the Reauthorization of the Traumatic Brain Injury Act, the 
     Secretary, acting through the Director of the Centers for 
     Disease Control and Prevention and the Director of the 
     National Institutes of Health and in consultation with the 
     Secretary of Defense and the Secretary of Veterans Affairs, 
     shall submit to the relevant committees of Congress a report 
     that contains the findings derived from an evaluation 
     concerning activities and procedures that can be implemented 
     by the Centers for Disease Control and Prevention, the 
     Department of Defense, and the Department of Veterans Affairs 
     to improve the collection and dissemination of compatible 
     epidemiological studies on the incidence and prevalence of 
     traumatic brain injury in the military and veterans 
     populations who return to civilian life. The report shall 
     include recommendations on the manner in which such agencies 
     can further collaborate on the development and improvement of 
     traumatic brain injury diagnostic tools and treatments.''.

     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.

[[Page 33649]]

       ``(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 
     including near drowning. 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 subsection (b)(2), by striking ``Labor and Human 
     Resources'' and inserting ``Health, Education, Labor, and 
     Pensions'';
       (2) in subparagraph (D) of subsection (d)(4), by striking 
     ``head brain injury'' and inserting ``brain injury''; and
       (3) 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)--
       (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 biennially, the Secretary'';
       (ii) by striking ``Commerce of the House of 
     Representatives, and to the Committee on Labor and Human 
     Resources'' and inserting ``Energy and Commerce of the House 
     of Representatives, and to the Committee on Health, 
     Education, Labor, and Pensions''; and
       (iii) by inserting ``and section 1253'' 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 trauma. 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''.

     SEC. 7. GAO STUDY WITH RESPECT TO MEMBERS OF THE ARMED 
                   FORCES.

       (a) In General.--The Comptroller General of the United 
     States shall conduct a national study regarding whether, and, 
     if so, to what extent, members of the armed forces who have 
     acquired a disability from serving in Operation Enduring 
     Freedom and Operation Iraqi Freedom are being reintegrated 
     into their communities. Such study shall specifically include 
     an examination of factors affecting the reintegration of such 
     members of the armed forces who have acquired a traumatic 
     brain injury into their communities, including an analysis 
     of--
       (1) the unavailability of suitable employment, housing, and 
     transportation;
       (2) the existence, availability, and capacity of community 
     care programs; and
       (3) the extent to which there is coordination of benefits 
     for these men and women.
       (b) Report.--Not later than 180 days after the date of 
     enactment of this Act, the Comptroller General of the United 
     States shall submit to the Committee on Veterans' Affairs and 
     the Committee on Health, Education, Labor, and Pensions of 
     the Senate and the Committee on Veterans' Affairs and the 
     Committee on Education and the Workforce of the House of 
     Representatives, a report summarizing the results of the 
     study conducted under subsection (a).

  Mr. KENNEDY. Mr. President, in passing the reauthorization of the 
Traumatic Brain Injury Act today, the Senate has taken an important 
step toward making a difference in the lives of some of our Nation's 
most deserving citizens: our soldiers and our children. It is a 
privilege to have worked with my colleague, Senator Hatch, on this 
legislation. It is an important and timely bill that helps an 
especially deserving group of people.
  Brain injuries have become the signature wound of the war in Iraq. Up 
to two-thirds of our wounded soldiers may have suffered such injuries. 
Here at home, an unacceptably large number of children from birth to 
age 14 experience traumatic brain injuries--approximately 475,000 a 
year and some of the most frequent of these injuries are to children 
under the age of five. In Massachusetts alone, more than 40,000 
individuals experience brain injuries each year.
  As a result of such injuries, over 5.3 million Americans are now 
living with a permanent disability. Today, we have taken a step toward 
ensuring that these citizens and their families will receive the best 
care we can provide.
  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 those with such injuries.

[[Page 33650]]

  When Congress approved the Traumatic Brain Injury Act as part of the 
Children's Health Act of 2000, we included a specific provision called 
the Protection and Advocacy for Individuals with Traumatic Brain Injury 
Program. This program has become essential because persons with these 
injuries have an array of needs beyond treatment and health care, 
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 persons--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, 
even though they can lead to reduced government expenditures, increased 
productivity, independence and community integration. Those who provide 
such assistance must have special skills, and their work is often time-
intensive.
  Our legislation allocates funds for CDC programs that will provide 
important information and data on injury prevention. A recent Institute 
of Medicine report showed that such programs work. Their benefit is 
obvious, and we must do all we can to expand this appropriation in the 
years ahead to meet the urgent and growing need for this assistance.
  A recent report by the Institute of Medicine calls the current TBI 
programs an ``overall success.'' It states that ``there is considerable 
value in providing funding,'' and ``it is worrisome that the modestly 
budgeted TBI Program continues to be vulnerable to budget cuts.''
  Current estimates show that the Federal Government spends less than 
$3 dollars per brain injury survivor on research and services. As the 
IOM study suggests, this program must be able to grow, so that each 
State has the resources necessary to maintain vital services and 
advocacy for the large number of Americans who sustain such a brain 
injury each year.
  Today's passage of this bipartisan bill moves us closer to continuing 
and strengthening these important programs which say to our Nation's 
wounded soldiers and injured children: ``You deserve the best we can 
provide''. I hope very much that Congress will continue to expand these 
programs, so that we can truly do all we can for these deserving 
individuals and their families.
  Mr. REID. Mr. President, I ask unanimous consent that the amendment 
at the desk be considered and agreed to; that the committee-reported 
substitute, as amended, be agreed to; that the bill, as amended, be 
read a third time, passed, and the motion to reconsider be laid upon 
the table; and that any statements relating to the bill be printed in 
the Record, with no intervening action or debate.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  The amendment (No. 3831) was agreed to.
  (The amendment is printed in today's Record under ``Text of 
Amendments.''
  The committee amendment in the nature of a substitute, as amended, 
was agreed to.
  The bill (S. 793), as amended, was ordered to be engrossed for a 
third reading, was read the third time, and passed.

                          ____________________