[House Report 104-652]
[From the U.S. Government Publishing Office]
104th Congress Report
HOUSE OF REPRESENTATIVES
2d Session 104-652
_______________________________________________________________________
TRAUMATIC BRAIN INJURY ACT OF 1996
_______
June 27, 1996.--Committed to the Committee of the Whole House on the
State of the Union and ordered to be printed
_______
Mr. Bliley, from the Committee on Commerce, submitted the following
R E P O R T
[To accompany H.R. 248]
[Including cost estimate of the Congressional Budget Office]
The Committee on Commerce, to whom was referred 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, having considered the same, report
favorably thereon with an amendment and recommend that the bill
as amended do pass.
CONTENTS
Page
The Amendment.................................................... 2
Purpose and Summary.............................................. 5
Background and Need for Legislation.............................. 5
Hearings......................................................... 6
Committee Consideration.......................................... 6
Roll Call Votes.................................................. 6
Committee Oversight Findings..................................... 6
Committee on Government Reform and Oversight..................... 6
New Budget Authority and Tax Expenditures........................ 6
Committee Cost Estimate.......................................... 7
Congressional Budget Office Estimate............................. 7
Inflationary Impact Statement.................................... 10
Advisory Committee Statement..................................... 10
Section-by-Section Analysis of the Legislation................... 10
Changes in Existing Law Made by the Bill, as Reported............ 12
The amendment is as follows:
Strike out all after the enacting clause and insert in lieu
thereof the following:
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 (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.''.
Purpose and Summary
The purpose of this legislation is to expand the efforts to
identify methods of preventing traumatic brain injury; expand
biomedical research efforts to prevent or minimize the severity
of dysfunction as a result of such an injury; and to improve
the delivery and quality of services through State
demonstration projects.
To achieve these goals, H.R. 248 authorizes:
1. The Centers for Disease Control and Prevention to
establish projects to prevent and reduce the incidence
of traumatic brain injury;
2. The National Institutes of Health to award grants
to conduct basic and applied research on developing new
methods for more effective diagnosis, therapies, and
continuum of care; and
3. The Health Resources and Services Administration
to make grants to States to carry out demonstration
programs to improve access to services regarding
traumatic brain injury.
Background and Need for Legislation
Traumatic brain injury (TBI) is defined as brain damage
from some externally inflicted trauma to the head that results
in significant impairment to an individual's physical,
psychosocial, and/or cognitive functional abilities. TBI has
become the number one killer and cause of disability of young
people in the United States. Motor vehicle accidents, sports
accidents, falls, and increasing violence are the major causes
of traumatic brain injury. Long known as the silent epidemic,
TBI can strike anyone--infant, youth, or elderly person--
without warning and with devastating results. TBI affects the
whole family and often results in huge medical and
rehabilitation expenses over a lifetime.
An estimated 1.9 million Americans experience traumatic
brain injuries each year. About half of these cases result in
at least short-term disability, and 52,000 people die as a
result of their injuries. The direct medical costs for
treatment of TBI have been estimated at more than $4 billion
annually.
Every year, over 90,000 people sustain severe brain
injuries leading to irreversible debilitating loss of function.
Because of the serious consequences of TBI and the failure of
human services systems and educational programs to meet their
needs properly, people with TBI want to be identified as people
with brain injuries, not to be labeled as having some other
disability. This is extremely important if appropriate services
are to be developed and targeted and prevention efforts are to
be conducted.
The Committee believes there needs to be more research to
find ways to repair damaged brain cells, improve memory loss,
and improve cognitive functions. TBI is different from other
disabilities due to the severity of cognitive loss. Most
rehabilitation programs are designed for people with physical
disabilities, not cognitive disabilities which require special
accommodations. In most States, there is no central point of
referral and no central authority to coordinate and target
appropriate services. The bill provides authority for the
conduct of basic and applied research with respect to TBI.
The Committee believes that as TBI is identified as a
unique form of brain injury, public awareness will increase and
more effective prevention policies inside and outside of
government can be adopted. The Committee recognizes the need
for coordination of TBI services at the Federal and State
levels and has authorized establishment of programs to promote
such activities.
Hearings
The Committee on Commerce has not held hearings on the
legislation.
Committee Consideration
On June 6, 1996, the Subcommittee on Health and Environment
met in open markup session and approved H.R. 248 for Full
Committee consideration, as amended, by a voice vote.
On June 13, 1996, the Committee on Commerce met in open
markup session and ordered H.R. 248 reported to the House, as
amended, by a voice vote, a quorum being present.
Rollcall Votes
Clause 2(l)(2)(B) of rule XI of the Rules of the House
requires the Committee to list the recorded votes on the motion
to report legislation and amendments thereto. There were no
recorded votes taken in connection with ordering H.R. 248
reported or in adopting the amendment. The voice votes taken in
Committee are as follows:
Bill: H.R. 248, a bill 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.
Amendment: Amendment offered by Mr. Greenwood re: provide
specified dollar amounts for the authorization of
appropriations.
Disposition: Agreed to, by a voice vote.
Motion: Motion by Mr. Bliley to order H.R. 248, as amended,
reported to the House.
Disposition: Agreed to, by a voice vote.
Committee Oversight Findings
Pursuant to clause 2(l)(3)(A) of Rule XI of the Rules of
the House of Representatives, the Committee has not held
oversight or legislative hearings on this legislation.
Committee on Government Reform and Oversight
Pursuant to clause 2(l)(3)(D) of rule XI of the Rules of
the House of Representatives, no oversight findings have been
submitted to the Committee by the Committee on Government
Reform and Oversight.
New Budget Authority and Tax Expenditures
In compliance with clause 2(l)(3)(B) of rule XI of the
Rules of the House of Representatives, the Committee states
that H.R. 248 would result in no new or increased budget
authority or tax expenditures or revenues.
Committee Cost Estimate
The Committee adopts as its own the cost estimate prepared
by the Director of the Congressional Budget Office pursuant to
section 403 of the Congressional Budget Act of 1974.
Congressional Budget Office Estimate
Pursuant to clause 2(l)(3)(C) of rule XI of the Rules of
the House of Representatives, the following is the cost
estimate provided by the Congressional Budget Office pursuant
to section 403 of the Congressional Budget Act of 1974:
U.S. Congress,
Congressional Budget Office,
Washington, DC, June 25, 1996.
Hon. Thomas J. Bliley, Jr.,
Chairman, Committee on Commerce,
House of Representatives, Washington, DC.
Dear Mr. Chairman: The Congressional Budget Office has
prepared the enclosed cost estimate for H.R. 248, as ordered
reported by the House Committee on Commerce on June 13, 1996.
Because enactment of H.R. 248 would not affect direct spending
or receipts, pay-as-you-go procedures would not apply to the
bill.
If you wish further details on this estimate, we will be
pleased to provide them.
Sincerely,
June E. O'Neill, Director.
Enclosure.
congressional budget office cost estimate
1. Bill number: H.R. 248.
2. Bill title: None.
3. Bill status: As ordered reported by House Committee on
Commerce on June 13, 1996.
4. Bill purpose: H.R. 248 would amend several parts of 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. It would also make
technical corrections to the Ryan White Care Act.
5. Estimated cost to the Federal Government: The following
table shows discretionary spending under H.R. 248.
Authorizations of appropriations would total $24.5 million for
fiscal years 1997 through 1999. No additional appropriations
would be authorized for fiscal years after 1999.
----------------------------------------------------------------------------------------------------------------
1997 1998 1999 2000 2001 2002
----------------------------------------------------------------------------------------------------------------
Section 3--Grants to States (Health Resources and Services
Administration):
Budget authority...................................... 5.0 5.0 5.0 ....... ....... .......
Outlays............................................... 1.8 3.5 5.0 3.3 1.5 .......
Section 4, Part (a)(1)(A)--Study (Centers for Disease
Control and Prevention):
Budget authority...................................... 3.0 3.0 3.0 ....... ....... .......
Outlays............................................... 1.1 2.2 2.8 1.9 1.0 .......
Section 4, Parts (a)(1)(B) and (a)(1)(C)--Study (National
Institutes of Health) and Part (b)--Consensus Conference
(National Institutes of Health):
Budget authority...................................... 0.5 ....... ....... ....... ....... .......
Outlays............................................... 0.2 0.3 ....... ....... ....... .......
-----------------------------------------------------
Total:
Budget authority................................ 8.5 8.0 8.0 ....... ....... .......
Outlays......................................... 3.0 6.0 7.8 5.2 2.5 .......
----------------------------------------------------------------------------------------------------------------
The costs of this bill would fall within budget function
550.
Estimated budget authority under Section 4, parts
(a)(1)(B), (a)(1)(C), and (b), is based on language in H.R.
248; however, CBO expects the $500,000 specified in this bill
would be insufficient to carry out the study and consensus
conference required under these parts. CBO estimates the cost
of conducting the conference under part (b) would be $250,000.
If only $500,000 budget authority were provided for all of the
parts and sub-parts specified above, only $250,000--slightly
more than the amount of one average NIH grant--would be
available for completing all of the research required under
sub-parts (a)(1)(B) and (a)(1)(c), including research to (1)
identify and analyze common therapeutic interventions, and (2)
develop practice guidelines for the rehabilitation of
individuals with TBI.
6. Basis of the estimate: H.R. 248 would authorize new
spending by the Health Resources and Services Administration
(HRSA), the Centers for Disease Control and Prevention (CDC),
and the National Institutes of Health (NIH). Estimated spending
under this bill would be subject to the availability of
appropriated funds.
Section 1 of this bill would authorize projects to reduce
the incidence of traumatic brain injury (TBI), where such
projects could be carried out directly by the CDC, or through
grants and contracts made by that agency to public and
nonprofit private entities. CBO estimates that this section
would entail no significant costs because (1) current law is
sufficiently broad to authorize projects for reducing the
incidence to TBI, (2) the CDC already allocates appropriated
funds to pay for staff salaries, projects, and grants related
to TBI prevention; and (3) the bill would not require spending
on such projects.
Section 2 would provide authority to the NIH to make awards
to public or nonprofit private entities for the conduct of
basic and applied research regarding traumatic brain injury. As
with Section 1, CBO estimates that this section would entail no
significant costs because current law is already sufficiently
broad to authorize research regarding TBI and because H.R. 248
would not require such research.
Section 3 would authorize HRSA to make grants to states for
the purpose of carrying out demonstration projects to improve
access to health and other services for the assessment and
treatment of traumatic brain injury. Such grants could be made
only where states establish an advisory board regarding TBI and
contribute at least $1 in cash for each $2 in federal funds
provided under the grant. This section would also require a
report describing the findings and results of programs
completed under such grants to states.
CBO assumes that the amounts authorized in Section 3 would
be appropriated as specified ($5 million for each of fiscal
years 1997 through 1999). The report required under this
section would be due two years following the date of enactment
of this legislation, before authorized demonstration projects
would be completed. Estimated outlays under this section are
based on historical spending patterns for HRSA.
Section 4 of H.R. 248 would require the completion of a
study and the conduct of a national consensus conference
regarding traumatic brain injury. CBO assumes that the CDC
would perform, together with state and local health-related
agencies, parts of the study related to TBI incidence and
prevalence and to the development of a uniform reporting
system. The NIH would conduct the consensus conference and
complete parts of the study related to therapeutic
interventions and practice guidelines.
For this section, CBO assumes (1) that amounts authorized
for parts of the study performed by the CDC would be
appropriated as specified ($3 million for each of the fiscal
years 1997 through 1999), and (2) that the $500,000 authorized
for the rest of the study and consensus conference would be
appropriated in full in fiscal year 1997. Estimated outlays are
based on historical spending patterns for both CDC and NIH.
Section 5 would make technical corrections to the Ryan
White Care Act. CBO estimates that this section would have no
budgetary impact.
7. Pay-as-you-go considerations: None.
8. Estimated cost to State, local and tribal governments:
H.R. 248 contains no intergovernmental mandates as defined in
P.L. 104-4. However, the bill would authorize funding for
various state-related projects. For fiscal years 1997 through
1999, the bill would authorize the annual appropriation of:
$5 million for grants to states, with a $2.5 million
state match, for the purpose of carrying out
demonstration projects that would improve access to
health and other services regarding traumatic brain
injury; and
$3 million for the Secretary of Health and Human
Services to conduct a study in collaboration with state
and local health-related agencies to determine the
incidence and prevalence of traumatic brain injury and
to develop a uniform reporting system.
If the federal government decides to carry out the projects
to prevent traumatic brain injury or research on these injuries
as permitted under this bill, state and local institutions may
receive the grant or contract to carry out these activities.
9. Estimated impact on the private sector: None.
10. Previous estimate: None.
11. Estimate prepared by: Federal Cost Estimate: Jennifer
Jenson. State and Local Cost Estimate: John Patterson.
12. Estimate approved by: Paul N. Van de Water, Assistant
Director for Budget Analysis.
Inflationary Impact Statement
Pursuant to clause 2(l)(4) of rule XI of the Rules of the
House of Representatives, the Committee finds that the bill
would have no inflationary impact.
Advisory Committee Statement
No advisory committees within the meaning of section 5(b)
of the Federal Advisory Committee Act are created by this
legislation.
Section-by-Section Analysis of the Legislation
Section 1. Programs of Centers for Disease Control and Prevention
Section 1 amends the Public Health Service Act by adding to
the Program on the Prevention and Control of Injuries a
provision regarding the prevention of traumatic brain injury
(TBI). This provision authorizes the Centers for Disease
Control and Prevention to carry out projects to reduce the
incidence of TBI. Such projects may include research to
identify strategies for, and public information and education
programs on, the prevention of such injury. The Secretary shall
ensure that these activities are carried out in coordination
with other Public Health Service agencies that carry out
activities regarding TBI.
This section also defines the term ``traumatic brain
injury'' as 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 Committee hopes that
the inclusion of this definition in statute will begin to give
people with TBI and their families increased recognition and
support. A definition is also necessary because the term has
been used in Federal and State statutes without a clear
definition of its meaning. The terms congenital brain damage,
head injury, organic brain damage, minimal brain dysfunction,
acquired brain injury, and a host of other terms, have been
used to define the injured brain without consistency of
definition.
Section 2. Programs of National Institutes of Health
Section 2 authorizes the National Institutes of Health to
make awards to conduct basic and applied research regarding
traumatic brain injury. Such research may include:
1. the development of new methods for more effective
diagnosis, measurement of degree of injury, post-injury
monitoring, and prognostic assessment of head injury;
2. the development, modification, and evaluation of
therapies that retard, prevent, or reverse brain damage
after head injury, that arrest further deterioration
following injury, and that provide restoration of
function;
3. the development of research on a continuum of care
from acute care through rehabilitation; and
4. the development of programs that increase the
participation of academic centers of excellence in head
injury treatment and rehabilitation research and
training.
Section 3. Programs of Health Resources and Services Administration
Section 3 authorizes the Health Resources and Services
Administration to make grants to carry out demonstration
projects to improve access to health and other services
regarding TBI. This program is authorized at $5 million for
each of Fiscal Years 1997 through 1999. To be eligible for such
a grant, a State must establish an advisory board to advise and
make recommendations on ways to improve services coordination
regarding TBI.
In addition, a grant may be awarded only if the State
agrees to make available, in cash, an amount that is not less
than a $1 for each $2 of Federal funds provided. No funds
provided to the State by the Federal government may be included
in determining the State's contribution.
The Secretary of Health and Human Services (the Secretary)
is required to submit a report on this grant program to the
appropriate Committees of Congress not later than 2 years after
enactment. The report shall include the findings and results of
the program, including measures of outcome and consumer
satisfaction.
Section 4. Study; consensus conference
Section 4 authorizes the Secretary to determine the
incidence and prevalence of TBI and to develop a uniform
reporting system. The bill authorizes $3 million for each of
Fiscal Years 1997 through 1999 to carry out these activities.
The Secretary is also required to report on the findings of
these activities to the appropriate Committees of Congress, not
later than 18 months after enactment.
This section also authorizes the Secretary to conduct a
study to identify common therapeutic interventions which are
used for the rehabilitation of individuals with such injuries,
an analysis of the effectiveness of such interventions, and the
adequacy of existing measures of outcomes. The Secretary is
also authorized to issue practice guidelines, if appropriate
scientific research becomes available. The Secretary is
required to report on the findings of this study not later than
three years after enactment.
In addition, this section directs the Secretary, acting
through the National Center for Medical Rehabilitation Research
within the National Institute of Child Health and Human
Development, to conduct a national consensus conference on
managing TBI and related rehabilitation concerns. The bill
authorizes an aggregate of $500,000 for the Fiscal Years 1997
through 1999 to conduct the study and carry out the consensus
conference.
Section 5. Technical amendments
Section 5 makes technical amendments to the Ryan White CARE
Act Amendments of 1996.
Changes in Existing Law Made by the Bill, as Reported
In compliance with clause 3 of rule XIII of the Rules of the
House of Representatives, changes in existing law made by the
bill, as reported, are shown as follows (existing law proposed
to be omitted is enclosed in black brackets, new matter is
printed in italic, existing law in which no change is proposed
is shown in roman):
PUBLIC HEALTH SERVICE ACT
* * * * * * *
TITLE III--GENERAL POWERS AND DUTIES OF PUBLIC HEALTH SERVICE
* * * * * * *
Part J--Prevention and Control of Injuries
* * * * * * *
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.
* * * * * * *
TITLE XII--TRAUMA CARE
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Part E--Miscellaneous Programs
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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.
* * * * * * *
Part F--Interagency Program for Trauma Research
SEC. 1261. ESTABLISHMENT OF PROGRAM.
(a) * * *
* * * * * * *
(d) Certain Activities of Program.--The Program shall
include--
(1) studies with respect to all phases of trauma
care, including prehospital, resuscitation, surgical
intervention, critical care, infection control, wound
healing, nutritional care and support, and medical
rehabilitation care;
(2) basic and clinical research regarding the
response of the body to trauma and the acute treatment
and medical rehabilitation of individuals who are the
victims of trauma; [and]
(3) basic and clinical research regarding trauma care
for pediatric and geriatric patients[.]; and
(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.
* * * * * * *
(h) Definitions.--For purposes of this section:
(1) * * *
* * * * * * *
(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.
* * * * * * *
TITLE XXVI--HIV HEALTH CARE SERVICES PROGRAM
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Part B--Care Grant Program
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Subpart II--Provisions Concerning Pregnancy and Perinatal Transmission
of HIV
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SEC. 2626. PERINATAL TRANSMISSION OF HIV DISEASE; CONTINGENT
REQUIREMENT REGARDING STATE GRANTS UNDER THIS PART.
(a) * * *
* * * * * * *
(d) Determination by Secretary.--Not later than 180 days
after the expiration of the 18-month period beginning on the
date on which the system is implemented under subsection (c),
the Secretary shall publish in the Federal Register a
determination of whether it has become a routine practice in
the provision of health care in the United States to carry out
each of the activities described in paragraphs [(1) through
(5)] (1) through (4) of section 2627. In making the
determination, the Secretary shall consult with the States and
with other public or private entities that have knowledge or
expertise relevant to the determination.
* * * * * * *
(f) Limitation Regarding Availability of Funds.--With respect
to an activity described in any of paragraphs [(1) through (5)]
(1) through (4) of section 2627, the requirements established
by a State under this section apply for purposes of this
section only to the extent that the following sources of funds
are available for carrying out the activity:
(1) Federal funds provided to the State in grants
under part B or under section 2625, or through other
Federal sources under which payments for routine HIV
testing, counseling or treatment are an eligible use.
(2) Funds that the State or private entities have
elected to provide, including through entering into
contracts under which health benefits are provided.
This section does not require any entity to expend non-
Federal funds.
* * * * * * *
PART F--DEMONSTRATION AND TRAINING
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Subpart II--AIDS Education and Training Centers
SEC. 2692. HIV/AIDS COMMUNITIES, SCHOOLS, AND CENTERS.
(a) Schools; Centers.--
(1) In general.--The Secretary may make grants and
enter into contracts to assist public and nonprofit
private entities and schools and academic health
science centers in meeting the costs of projects--
(A) training health personnel, including
practitioners in [title XXVI programs] programs
under this title and other community providers,
in the diagnosis, treatment, and prevention of
HIV [infection and] disease, including the
prevention of the perinatal transmission of the
disease and including measures for the
prevention and treatment of opportunistic
infections;
* * * * * * *
[(c) Definition.--For purposes of this section:
[(1) The term ``HIV disease'' means infection with
the human immunodeficiency virus, and includes any
condition arising from such infection.
[(2) The term ``human immunodeficiency virus'' means
the etiologic agent for acquired immune deficiency
syndrome.
[(d) Authorization of Appropriations.--
[(1) Schools; centers.--For the purpose of grants
under subsection (a), there is authorized to be
appropriated $23,000,000 for each of the fiscal years
1993 through 1995.
[(2) Dental schools.--For the purpose of grants under
subsection (b), there is authorized to be appropriated
$7,000,000 for each of the fiscal years 1993 through
1995.
[(d) Authorization of Appropriations.--There are authorized
to be appropriated to carry out this section, such sums as may
be necessary for each of the fiscal years 1996 through 2000.]
(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.