[House Report 108-453]
[From the U.S. Government Publishing Office]



108th Congress                                                   Report
                        HOUSE OF REPRESENTATIVES
 2d Session                                                     108-453

======================================================================



 
              STROKE TREATMENT AND ONGOING PREVENTION ACT

                                _______
                                

 March 30, 2004.--Committed to the Committee of the Whole House on the 
              State of the Union and ordered to be printed

                                _______
                                

    Mr. Barton of Texas, from the Committee on Energy and Commerce, 
                        submitted the following

                              R E P O R T

                        [To accompany H.R. 3658]

      [Including cost estimate of the Congressional Budget Office]

  The Committee on Energy and Commerce, to whom was referred 
the bill (H.R. 3658) to amend the Public Health Service Act to 
strengthen education, prevention, and treatment programs 
relating to stroke, 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
Amendment........................................................     1
Purpose and Summary..............................................     5
Background and Need for Legislation..............................     5
Hearings.........................................................     5
Committee Consideration..........................................     5
Committee Votes..................................................     5
Committee Oversight Findings.....................................     5
Statement of General Performance Goals and Objectives............     6
New Budget Authority, Entitlement Authority, and Tax Expenditures     6
Committee Cost Estimate..........................................     6
Congressional Budget Office Estimate.............................     6
Federal Mandates Statement.......................................     8
Advisory Committee Statement.....................................     8
Constitutional Authority Statement...............................     8
Applicability to Legislative Branch..............................     8
Section-by-Section Analysis of the Legislation...................     8
Changes in Existing Law Made by the Bill, as Reported............    11

                               Amendment

    The amendment is as follows:
    Strike all after the enacting clause and insert the 
following:

SECTION 1. SHORT TITLE.

  This Act may be cited as the ``Stroke Treatment and Ongoing 
Prevention Act''.

SEC. 2. AMENDMENTS TO PUBLIC HEALTH SERVICE ACT REGARDING STROKE 
                    PROGRAMS.

  (a) Stroke Education and Information Programs.--Title III of the 
Public Health Service Act (42 U.S.C. 241 et seq.) is amended by adding 
at the end the following:

 ``PART R--STROKE EDUCATION, INFORMATION, AND DATA COLLECTION PROGRAMS

``SEC. 399AA. STROKE PREVENTION AND EDUCATION CAMPAIGN.

  ``(a) In General.--The Secretary shall carry out an education and 
information campaign to promote stroke prevention and increase the 
number of stroke patients who seek immediate treatment.
  ``(b) Authorized Activities.--In implementing the education and 
information campaign under subsection (a), the Secretary may--
          ``(1) make public service announcements about the warning 
        signs of stroke and the importance of treating stroke as a 
        medical emergency;
          ``(2) provide education regarding ways to prevent stroke and 
        the effectiveness of stroke treatment; and
          ``(3) carry out other activities that the Secretary 
        determines will promote prevention practices among the general 
        public and increase the number of stroke patients who seek 
        immediate care.
  ``(c) Measurements.--In implementing the education and information 
campaign under subsection (a), the Secretary shall--
          ``(1) measure public awareness before the start of the 
        campaign to provide baseline data that will be used to evaluate 
        the effectiveness of the public awareness efforts;
          ``(2) establish quantitative benchmarks to measure the impact 
        of the campaign over time; and
          ``(3) measure the impact of the campaign not less than once 
        every 2 years or, if determined appropriate by the Secretary, 
        at shorter intervals.
  ``(d) No Duplication of Effort.--In carrying out this section, the 
Secretary shall avoid duplicating existing stroke education efforts by 
other Federal Government agencies.
  ``(e) Consultation.--In carrying out this section, the Secretary may 
consult with organizations and individuals with expertise in stroke 
prevention, diagnosis, treatment, and rehabilitation.

``SEC. 399BB. PAUL COVERDELL NATIONAL ACUTE STROKE REGISTRY AND 
                    CLEARINGHOUSE.

  ``The Secretary, acting through the Centers for Disease Control and 
Prevention, shall maintain the Paul Coverdell National Acute Stroke 
Registry and Clearinghouse by--
          ``(1) continuing to develop and collect specific data points 
        and appropriate benchmarks for analyzing care of acute stroke 
        patients;
          ``(2) collecting, compiling, and disseminating information on 
        the achievements of, and problems experienced by, State and 
        local agencies and private entities in developing and 
        implementing emergency medical systems and hospital-based 
        quality of care interventions; and
          ``(3) carrying out any other activities the Secretary 
        determines to be useful to maintain the Paul Coverdell National 
        Acute Stroke Registry and Clearinghouse to reflect the latest 
        advances in all forms of stroke care.

``SEC. 399CC. STROKE DEFINITION.

  ``For purposes of this part, the term `stroke' means a `brain attack' 
in which blood flow to the brain is interrupted or in which a blood 
vessel or aneurysm in the brain breaks or ruptures.

``SEC. 399DD. AUTHORIZATION OF APPROPRIATIONS.

  ``There is authorized to be appropriated to carry out this part 
$5,000,000 for each of fiscal years 2005 through 2009.''.
  (b) Emergency Medical Professional Development.--Section 1251 of the 
Public Health Service Act (42 U.S.C. 300d-51) is amended to read as 
follows:

``SEC. 1251. MEDICAL PROFESSIONAL DEVELOPMENT IN ADVANCED STROKE AND 
                    TRAUMATIC INJURY TREATMENT AND PREVENTION.

  ``(a) Residency and Other Professional Training.--The Secretary may 
make grants to public and nonprofit entities for the purpose of 
planning, developing, and enhancing approved residency training 
programs and other professional training for appropriate health 
professions in emergency medicine, including emergency medical services 
professionals, to improve stroke and traumatic injury prevention, 
diagnosis, treatment, and rehabilitation.
  ``(b) Continuing Education on Stroke and Traumatic Injury.--
          ``(1) Grants.--The Secretary, acting through the 
        Administrator of the Health Resources and Services 
        Administration, may make grants to qualified entities for the 
        development and implementation of education programs for 
        appropriate health care professionals in the use of newly 
        developed diagnostic approaches, technologies, and therapies 
        for health professionals involved in the prevention, diagnosis, 
        treatment, and rehabilitation of stroke or traumatic injury.
          ``(2) Distribution of grants.--In awarding grants under this 
        subsection, the Secretary shall give preference to qualified 
        entities that will train health care professionals that serve 
        areas with a significant incidence of stroke or traumatic 
        injuries.
          ``(3) Application.--A qualified entity desiring a grant under 
        this subsection shall submit to the Secretary an application at 
        such time, in such manner, and containing such information as 
        the Secretary may require, including a plan for the rigorous 
        evaluation of activities carried out with amounts received 
        under the grant.
          ``(4) Definitions.--For purposes of this subsection:
                  ``(A) The term `qualified entity' means a consortium 
                of public and private entities, such as universities, 
                academic medical centers, hospitals, and emergency 
                medical systems that are coordinating education 
                activities among providers serving in a variety of 
                medical settings.
                  ``(B) The term `stroke' means a `brain attack' in 
                which blood flow to the brain is interrupted or in 
                which a blood vessel or aneurysm in the brain breaks or 
                ruptures.
  ``(c) Report.--Not later than 1 year after the allocation of grants 
under this section, the Secretary shall submit to the Committee on 
Health, Education, Labor, and Pensions of the Senate and the Committee 
on Energy and Commerce of the House of Representatives a report on the 
results of activities carried out with amounts received under this 
section.
  ``(d) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section $4,000,000 for each of fiscal 
years 2005 through 2009. The Secretary shall equitably allocate the 
funds authorized to be appropriated under this section between efforts 
to address stroke and efforts to address traumatic injury.''.

SEC. 3. PILOT PROJECT ON TELEHEALTH STROKE TREATMENT.

  (a) Establishment.--Part D of title III of the Public Health Service 
Act (42 U.S.C. 254b et seq.) is amended by inserting after section 330L 
the following:

``SEC. 330M. TELEHEALTH STROKE TREATMENT GRANT PROGRAM.

  ``(a) Grants.--The Secretary may make grants to States, and to 
consortia of public and private entities located in any State that is 
not a grantee under this section, to conduct a 5-year pilot project 
over the period of fiscal years 2005 through 2009 to improve stroke 
patient outcomes by coordinating health care delivery through 
telehealth networks.
  ``(b) Administration.--The Secretary shall administer this section 
through the Director of the Office for the Advancement of Telehealth.
  ``(c) Consultation.--In carrying out this section, for the purpose of 
better coordinating program activities, the Secretary shall consult 
with--
          ``(1) officials responsible for other Federal programs 
        involving stroke research and care, including such programs 
        established by the Stroke Treatment and Ongoing Prevention Act; 
        and
          ``(2) organizations and individuals with expertise in stroke 
        prevention, diagnosis, treatment, and rehabilitation.
  ``(d) Use of Funds.--
          ``(1) In general.--The Secretary may not make a grant to a 
        State or a consortium under this section unless the State or 
        consortium agrees to use the grant for the purpose of--
                  ``(A) identifying entities with expertise in the 
                delivery of high-quality stroke prevention, diagnosis, 
                treatment, and rehabilitation;
                  ``(B) working with those entities to establish or 
                improve telehealth networks to provide stroke treatment 
                assistance and resources to health care professionals, 
                hospitals, and other individuals and entities that 
                serve stroke patients;
                  ``(C) informing emergency medical systems of the 
                location of entities identified under subparagraph (A) 
                to facilitate the appropriate transport of individuals 
                with stroke symptoms;
                  ``(D) establishing networks to coordinate 
                collaborative activities for stroke prevention, 
                diagnosis, treatment, and rehabilitation;
                  ``(E) improving access to high-quality stroke care, 
                especially for populations with a shortage of stroke 
                care specialists and populations with a high incidence 
                of stroke; and
                  ``(F) conducting ongoing performance and quality 
                evaluations to identify collaborative activities that 
                improve clinical outcomes for stroke patients.
          ``(2) Establishment of consortium.--The Secretary may not 
        make a grant to a State under this section unless the State 
        agrees to establish a consortium of public and private 
        entities, including universities and academic medical centers, 
        to carry out the activities described in paragraph (1).
          ``(3) Prohibition.--The Secretary may not make a grant under 
        this section to a State that has an existing telehealth network 
        that is or may be used for improving stroke prevention, 
        diagnosis, treatment, and rehabilitation, or to a consortium 
        located in such a State, unless the State or consortium agrees 
        that--
                  ``(A) the State or consortium will use an existing 
                telehealth network to achieve the purpose of the grant; 
                and
                  ``(B) the State or consortium will not establish a 
                separate network for such purpose.
  ``(e) Priority.--In selecting grant recipients under this section, 
the Secretary shall give priority to any applicant that submits a plan 
demonstrating how the applicant, and where applicable the members of 
the consortium described in subsection (d)(2), will use the grant to 
improve access to high-quality stroke care for populations with 
shortages of stroke-care specialists and populations with a high 
incidence of stroke.
  ``(f) Grant Period.--The Secretary may not award a grant to a State 
or a consortium under this section for any period that--
          ``(1) is greater than 3 years; or
          ``(2) extends beyond the end of fiscal year 2009.
  ``(g) Restriction on Number of Grants.--In carrying out the 5-year 
pilot project under this section, the Secretary may not award more than 
7 grants.
  ``(h) Application.--To seek a grant under this section, a State or a 
consortium of public and private entities shall submit an application 
to the Secretary in such form, in such manner, and containing such 
information as the Secretary may require. At a minimum, the Secretary 
shall require each such application to outline how the State or 
consortium will establish baseline measures and benchmarks to evaluate 
program outcomes.
  ``(i) Definition.--In this section, the term `stroke' means a `brain 
attack' in which blood flow to the brain is interrupted or in which a 
blood vessel or aneurysm in the brain breaks or rupture.
  ``(j) Authorization of Appropriations.--There are authorized to be 
appropriated to carry out this section $10,000,000 for fiscal year 
2005, $13,000,000 for fiscal year 2006, $15,000,000 for fiscal year 
2007, $8,000,000 for fiscal year 2008, and $4,000,000 for fiscal year 
2009.''.
  (b) Study; Reports.--
          (1) Final report.--Not later than March 31, 2010, the 
        Secretary of Health and Human Services shall conduct a study of 
        the results of the telehealth stroke treatment grant program 
        under section 330M of the Public Health Service Act (added by 
        subsection (a)) and submit to the Congress a report on such 
        results that includes the following:
                  (A) An evaluation of the grant program outcomes, 
                including quantitative analysis of baseline and 
                benchmark measures.
                  (B) Recommendations on how to promote stroke networks 
                in ways that improve access to clinical care in rural 
                and urban areas and reduce the incidence of stroke and 
                the debilitating and costly complications resulting 
                from stroke.
                  (C) Recommendations on whether similar telehealth 
                grant programs could be used to improve patient 
                outcomes in other public health areas.
          (2) Interim reports.--The Secretary of Health and Human 
        Services may provide interim reports to the Congress on the 
        telehealth stroke treatment grant program under section 330M of 
        the Public Health Service Act (added by subsection (a)) at such 
        intervals as the Secretary determines to be appropriate.

SEC. 4. RULE OF CONSTRUCTION.

  Nothing in this Act shall be construed to authorize the Secretary of 
Health and Human Services to establish Federal standards for the 
treatment of patients or the licensure of health care professionals.

                          Purpose and Summary

    The Stroke Treatment and Ongoing Prevention Act, H.R. 3658, 
amends the Public Health Service Act to strengthen education, 
prevention, and treatment programs to improve health outcomes 
for stroke patients.

                  Background and Need for Legislation

    Stroke is the third leading cause of death in America and a 
major contributor to long-term disability. A stroke occurs when 
the blood supply to part of the brain is suddenly interrupted 
(ischemic) or when a blood vessel in the brain bursts, spilling 
blood into the spaces surrounding the brain cells 
(hemorrhagic). Although the symptoms of a stroke are easily 
recognizable--such as sudden numbness or weakness on one side 
of the body, difficulty seeing, and loss of balance or 
coordination--not all patients suffering a stroke seek help in 
a timely manner. When a stroke is diagnosed and treated within 
the first few hours, damaged cells can be saved, strengthening 
the chance of recovery. Recent studies have demonstrated that 
stroke patients who receive care in a timely manner at 
facilities with highly trained health care professionals are 
more likely to have better health outcomes. The American Heart 
Association reports that 700,000 Americans suffer from a stroke 
each year and nearly 170,000 die annually. They estimate that 
on average someone suffers a stroke every 45 seconds and every 
3 minutes someone dies from a stroke.

                                Hearings

    The Committee on Energy and Commerce has not held hearings 
on the legislation.

                        Committee Consideration

    On Wednesday, January 28, 2004, the Subcommittee on Health 
met in open markup session and approved H.R. 3658 for Full 
Committee consideration, as amended, by a voice vote, a quorum 
being present. On Wednesday, March 3, 2004, the Full Committee 
met in open markup session and ordered H.R. 3658 favorably 
reported to the House, as amended, by a voice vote, a quorum 
being present.

                            Committee Votes

    Clause 3(b) of rule XIII of the Rules of the House of 
Representatives requires the Committee to list the record votes 
on the motion to report legislation and amendments thereto. 
There were no record votes taken in connection with ordering 
H.R. 3658 reported. A motion by Mr. Barton to order H.R. 3658 
reported to the House, as amended, was agreed to by a voice 
vote.

                      Committee Oversight Findings

    Pursuant to clause 3(c)(1) of rule XIII of the Rules of the 
House of Representatives, the Committee has not held oversight 
or legislative hearings on this legislation.

         Statement of General Performance Goals and Objectives

    H.R. 3658 seeks to improve health outcomes for stroke 
patients.

   New Budget Authority, Entitlement Authority, and Tax Expenditures

    In compliance with clause 3(c)(2) of rule XIII of the Rules 
of the House of Representatives, the Committee finds that H.R. 
3658, the Stroke Treatment and Ongoing Prevention Act, would 
result in no new or increased budget authority, entitlement 
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 402 of the Congressional Budget Act of 1974.

                  Congressional Budget Office Estimate

    Pursuant to clause 3(c)(3) of rule XIII of the Rules of the 
House of Representatives, the following is the cost estimate 
provided by the Congressional Budget Office pursuant to section 
402 of the Congressional Budget Act of 1974:

                                     U.S. Congress,
                               Congressional Budget Office,
                                    Washington, DC, March 19, 2004.
Hon. Joe Barton,
Chairman, Committee on Energy and Commerce,
House of Representatives, Washington, DC.
    Dear Mr. Chairman: The Congressional Budget Office has 
prepared the enclosed cost estimate for H.R. 3658, the Stroke 
Treatment and Ongoing Prevention Act.
    If you wish further details on this estimate, we will be 
pleased to provide them. The CBO staff contact is Shawn Bishop.
            Sincerely,
                                         Elizabeth Robinson
                               (For Douglas Holtz-Eakin, Director).
    Enclosure.

H.R. 3658--Stroke Treatment and Ongoing Prevention Act

    Summary: H.R. 3658 would amend the Public Health Service 
Act to authorize the Secretary of the Department of Health and 
Human Services (HHS) to engage in activities designed to 
increase knowledge and awareness of stroke prevention and 
treatment. H.R. 3658 would require the Secretary to conduct 
educational campaigns, maintain a national registry, and 
establish an information clearinghouse related to the disease. 
The bill would authorize the appropriation of $5 million each 
year from 2005 through 2009 for these activities.
    In addition, H.R. 3658 would allow the Secretary to make 
grants to states and other public and private entities to 
develop medical professional training programs and telehealth 
networks that seek to coordinate stroke care and improve 
patient outcomes. The bill would authorize the appropriation of 
$14 million in 2005 and $70 million over the 2005-2009 period 
for the grant programs and for a study and reports evaluating 
the telehealth grant program.
    Assuming appropriation of the specified amounts, CBO 
estimates that implementing H.R. 3658 would cost $6 million in 
2005 and a total of $81 million from 2005 through 2009.
    The legislation would not affect direct spending or 
receipts. H.R. 3658 contains no private-sector or 
intergovernmental mandates as defined in the Unfunded Mandates 
Reform Act.
    Estimated cost to the Federal Government: The estimated 
budgetary impact of H.R. 3658 is shown in the following table. 
For purposes of this estimate, CBO assumes that outlays will 
follow historical spending rates for similar activities. The 
costs of this legislation fall within budget function 550 
(health).

----------------------------------------------------------------------------------------------------------------
                                                                  By fiscal year, in millions of dollars--
                                                           -----------------------------------------------------
                                                              2004     2005     2006     2007     2008     2009
----------------------------------------------------------------------------------------------------------------
                                  CHANGES IN SPENDING SUBJECT TO APPROPRIATION

Authorization Level.......................................        0       19       22       24       17       13
Estimated Outlays.........................................        0        6       17       21       21       16
----------------------------------------------------------------------------------------------------------------

    Basis of estimate: H.R. 3658 would expand the current 
duties of the Department of Health and Human Services. The 
duties would include educating the public about strokes and, 
through the Centers for Disease Control and Prevention (CDC), 
maintaining a national registry and clearinghouse to collect 
and coordinate the analysis of stroke treatments. Recently, the 
CDC evaluated eight pilot tests for a national stroke registry. 
Although not specifically named, the CDC is also the most 
likely agency within HHS to carry out the public awareness 
campaign. The bill would authorize appropriations of $5 million 
in each fiscal year over the 2005-2009 period for these 
activities. Based on historical spending patterns for similar 
activities, CBO estimates that outlays would total about $20 
million over the 2005-2009 period, assuming appropriation of 
the authorized amounts.
    In addition, H.R. 3658 would allow the Health Resources and 
Services Agency (HRSA) to make grants to public and private 
entities for the purpose of training medical personnel, 
including emergency medical professionals, about strokes and 
the latest ways to treat the disease. The bill also would allow 
HRSA to make grants to states and other qualified entities for 
the purpose of developing telehealth networks to coordinate 
stroke care and improve patient outcomes. (Telehealth often 
refers to the ability to diagnose, monitor, or treat patients 
from afar using information technology.) Telehealth grantees 
would carry out five-year pilot projects over fiscal years 2005 
through 2009. HRSA would conduct a study and report to the 
Congress on the effectiveness of the telehealth grant program. 
CBO assumes that grants would be awarded starting in 2005. The 
bill would authorize the appropriation of $14 million in fiscal 
year 2005 and $70 million over the 2005-2009 period for such 
grants. Based on historical spending patterns for similar 
activities, CBO estimates that outlays would total $69 million 
over the 2005-2009 period, assuming appropriation of the 
authorized amounts.
    Estimate prepared by: Federal Outlays: Shawn Bishop and 
Margaret Nowak; Impact on State, Local, and Tribal Governments: 
Leo Lex; and Impact on the Private Sector: Meena Fernandes.
    Estimate approved by: Peter H. Fontaine, Deputy Assistant 
Director for Budget Analysis.

                       Federal Mandates Statement

    The Committee adopts as its own the estimate of Federal 
mandates prepared by the Director of the Congressional Budget 
Office pursuant to section 423 of the Unfunded Mandates Reform 
Act.

                      Advisory Committee Statement

    No advisory committees within the meaning of section 5(b) 
of the Federal Advisory Committee Act were created by this 
legislation.

                   Constitutional Authority Statement

    Pursuant to clause 3(d)(1) of rule XIII of the Rules of the 
House of Representatives, the Committee finds that the 
Constitutional authority for this legislation is provided in 
Article I, section 8, clause 3, which grants Congress the power 
to regulate commerce with foreign nations, among the several 
States, and with the Indian tribes.

                  Applicability to Legislative Branch

    The Committee finds that the legislation does not relate to 
the terms and conditions of employment or access to public 
services or accommodations within the meaning of section 
102(b)(3) of the Congressional Accountability Act.

             Section-by-Section Analysis of the Legislation


Section 1. Short title

    Section 1 establishes the short title of the bill as the 
``Stroke Treatment and Ongoing Prevention Act.''

Section 2. Amendments to the Public Health Service Act regarding stroke 
        programs

    Section 2 amends the Public Health Service Act to 
strengthen education, prevention, and treatment programs to 
improve health outcomes for stroke patients.
    To increase public awareness of the signs of stroke, 
section 2 amends Title III of the Public Health Service Act to 
authorize the Secretary of the Department of Health and Human 
Services to carry out an education and information campaign to 
promote stroke prevention and increase the number of stroke 
patients who seek immediate treatment. The Secretary is 
authorized to (1) make public service announcements about the 
warning signs of stroke and the importance of treating stroke 
as a medical emergency; (2) provide education regarding ways to 
prevent stroke and the effectiveness of stroke treatment; and, 
(3) carry out other activities that will promote prevention 
practices among the general public and increase the number of 
stroke patients who seek immediate care. The Secretary is 
required to measure public awareness before the start of the 
campaign to provide baseline data that can be used to establish 
quantitative benchmarks to measure the impact of the campaign 
over time. The Secretary must report on these measurements not 
less than once every two years, or at shorter intervals. The 
Secretary must avoid duplicating existing stroke education 
efforts by other Federal agencies. The Secretary may also 
consult with organizations and individuals with expertise in 
stroke prevention, diagnosis, treatment, and rehabilitation.
    To expand research information about stroke patients, 
section 2 also reauthorizes the Paul Coverdell National Acute 
Stroke Registry and Clearinghouse at the Centers for Disease 
Control and Prevention (CDC). For purposes of this part, the 
term ``stroke'' means a ``brain attack'' in which blood flow to 
the brain is interrupted or in which a blood vessel or aneurysm 
in the brain breaks or ruptures. For the public education and 
registry provisions, section 2 authorizes $5 million for each 
of fiscal years 2005 through 2009.
    To improve medical professional development in advanced 
stroke and traumatic injury treatment and prevention, section 2 
amends section 1251 of the Public Health Service Act to 
authorize two new grant programs. The first grant program 
created in this section authorizes the Secretary to make grants 
to public and nonprofit entities for the purpose of planning, 
developing, and enhancing approved residency training programs 
and other training for appropriate health professions in 
emergency medicine to improve stroke and traumatic injury 
prevention, diagnosis, treatment, and rehabilitation.
    The second grant program authorizes the Secretary, acting 
through the Administrator of the Health Resources and Services 
Administration (HRSA), to make grants to a consortium of public 
and private entities for the development and implementation of 
education programs for appropriate health care professionals in 
the use of newly developed diagnostic approaches, technologies, 
and therapies to treat stroke or traumatic injury. The 
Secretary must give preference to qualified entities that will 
train health care professionals that serve areas with a 
significant incidence of stroke or traumatic injuries. The term 
``qualified entity'' is defined as a consortium of public and 
private entities, such as universities, academic medical 
centers, hospitals, and emergency medical systems that are 
coordinating education activities among providers serving in a 
variety of medical settings. The Committee does not intend for 
the examples outlined in the statute to be an exhaustive list 
of entities. Further, the Committee expects HRSA to award these 
to real consortiums, groups of organizations formed to 
undertake the continuing education activities to a level that 
no one organization could accomplish by itself. The Committee 
strongly encourages HRSA to recognize the diverse training of 
health care professionals who treat stroke patients when 
awarding grants. For example, interventional radiologists who 
employ minimally invasive stroke treatments and therapies 
should be considered as well as all other health care 
professionals who directly treat stroke patients.
    The Secretary must report on the results of the activities 
of the two medical professional development grant programs no 
later than one year after the allocation of grants. This 
section authorizes $4 million for each of fiscal years 2005 
through 2009 for the two medical professional development grant 
programs. The Secretary must equitably allocate the funds 
appropriated between efforts to address stroke and efforts to 
address traumatic injury.

Section 3. Pilot project on telehealth stroke treatment

    Section 3 amends Part D of Title III of the Public Health 
Service Act to establish a five-year pilot project to improve 
stroke patient outcomes by coordinating health care delivery 
through existing telehealth networks. The Secretary, acting 
through the Director of the Office for the Advancement of 
Telehealth, is authorized to make up to seven grants to states 
or a consortium of states or political subdivisions for a 
period of up to three years over fiscal years 2005-2009.
    Grant recipients must use the funding to accomplish all of 
the following activities: (1) identify entities with expertise 
in the delivery of high-quality stroke prevention, diagnosis, 
treatment, and rehabilitation; (2) work with these entities to 
establish or improve telehealth networks to provide stroke 
treatment assistance and resources to health care 
professionals, hospitals, and other individuals and entities 
that serve stroke patients; (3) inform emergency medical 
systems of the location of entities identified to facilitate 
appropriate transportation; (4) establish networks to 
coordinate collaborative activities for stroke prevention, 
diagnosis, treatment, and rehabilitation; (5) improve access to 
high-quality stroke care, especially for populations with a 
shortage of stroke care specialists and populations with a high 
incidence of stroke; and, (6) conduct ongoing performance and 
quality evaluations to identify collaborative activities that 
improve clinical outcomes for stroke patients. The Secretary 
may not award a grant to a state unless the state agrees to 
establish a consortium of public and private entities to carry 
out the activities of the grant. The Secretary may not make a 
grant to a state that has an existing telehealth network that 
is or may be used for the purposes of the grant unless the 
state agrees to use the existing telehealth network to achieve 
the purpose of the grant and the state will not establish a 
separate network for the same purpose. The Secretary must give 
priority to any applicant that submits a plan detailing 
specifically how the grant will improve access to high-quality 
stroke care for populations with shortages of stroke care 
specialists and populations with a high incidence of stroke.
    The Secretary is required to consult with officials 
responsible for other Federal programs involving stroke 
research and care and organizations and individuals with 
expertise in stroke prevention, diagnosis, treatment, and 
rehabilitation to better coordinate program activities. Grant 
recipients are required to establish baseline measures and 
benchmarks to evaluate program outcomes. Not later than March 
31, 2010, the Secretary of Health and Human Services is 
required to report to Congress on the pilot project outcomes, 
including recommendations on how to promote stroke networks and 
recommendations on whether similar telehealth grant programs 
could be used to improve patient outcomes in other public 
health areas.
    The pilot project is authorized at $10 million for fiscal 
year 2005, $13 million for fiscal year 2006, $15 million for 
fiscal year 2007, $8 million for fiscal year 2008, and $4 
million for fiscal year 2009.

         Changes in Existing Law Made by the Bill, as Reported

  In compliance with clause 3(e) 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 D--Primary Health Care

           *       *       *       *       *       *       *



Subpart I--Health Centers

           *       *       *       *       *       *       *



SEC. 330M. TELEHEALTH STROKE TREATMENT GRANT PROGRAM.

  (a) Grants.--The Secretary may make grants to States, and to 
consortia of public and private entities located in any State 
that is not a grantee under this section, to conduct a 5-year 
pilot project over the period of fiscal years 2005 through 2009 
to improve stroke patient outcomes by coordinating health care 
delivery through telehealth networks.
  (b) Administration.--The Secretary shall administer this 
section through the Director of the Office for the Advancement 
of Telehealth.
  (c) Consultation.--In carrying out this section, for the 
purpose of better coordinating program activities, the 
Secretary shall consult with--
          (1) officials responsible for other Federal programs 
        involving stroke research and care, including such 
        programs established by the Stroke Treatment and 
        Ongoing Prevention Act; and
          (2) organizations and individuals with expertise in 
        stroke prevention, diagnosis, treatment, and 
        rehabilitation.
  (d) Use of Funds.--
          (1) In general.--The Secretary may not make a grant 
        to a State or a consortium under this section unless 
        the State or consortium agrees to use the grant for the 
        purpose of--
                  (A) identifying entities with expertise in 
                the delivery of high-quality stroke prevention, 
                diagnosis, treatment, and rehabilitation;
                  (B) working with those entities to establish 
                or improve telehealth networks to provide 
                stroke treatment assistance and resources to 
                health care professionals, hospitals, and other 
                individuals and entities that serve stroke 
                patients;
                  (C) informing emergency medical systems of 
                the location of entities identified under 
                subparagraph (A) to facilitate the appropriate 
                transport of individuals with stroke symptoms;
                  (D) establishing networks to coordinate 
                collaborative activities for stroke prevention, 
                diagnosis, treatment, and rehabilitation;
                  (E) improving access to high-quality stroke 
                care, especially for populations with a 
                shortage of stroke care specialists and 
                populations with a high incidence of stroke; 
                and
                  (F) conducting ongoing performance and 
                quality evaluations to identify collaborative 
                activities that improve clinical outcomes for 
                stroke patients.
          (2) Establishment of consortium.--The Secretary may 
        not make a grant to a State under this section unless 
        the State agrees to establish a consortium of public 
        and private entities, including universities and 
        academic medical centers, to carry out the activities 
        described in paragraph (1).
          (3) Prohibition.--The Secretary may not make a grant 
        under this section to a State that has an existing 
        telehealth network that is or may be used for improving 
        stroke prevention, diagnosis, treatment, and 
        rehabilitation, or to a consortium located in such a 
        State, unless the State or consortium agrees that--
                  (A) the State or consortium will use an 
                existing telehealth network to achieve the 
                purpose of the grant; and
                  (B) the State or consortium will not 
                establish a separate network for such purpose.
  (e) Priority.--In selecting grant recipients under this 
section, the Secretary shall give priority to any applicant 
that submits a plan demonstrating how the applicant, and where 
applicable the members of the consortium described in 
subsection (d)(2), will use the grant to improve access to 
high-quality stroke care for populations with shortages of 
stroke-care specialists and populations with a high incidence 
of stroke.
  (f) Grant Period.--The Secretary may not award a grant to a 
State or a consortium under this section for any period that--
          (1) is greater than 3 years; or
          (2) extends beyond the end of fiscal year 2009.
  (g) Restriction on Number of Grants.--In carrying out the 5-
year pilot project under this section, the Secretary may not 
award more than 7 grants.
  (h) Application.--To seek a grant under this section, a State 
or a consortium of public and private entities shall submit an 
application to the Secretary in such form, in such manner, and 
containing such information as the Secretary may require. At a 
minimum, the Secretary shall require each such application to 
outline how the State or consortium will establish baseline 
measures and benchmarks to evaluate program outcomes.
  (i) Definition.--In this section, the term ``stroke'' means a 
``brain attack'' in which blood flow to the brain is 
interrupted or in which a blood vessel or aneurysm in the brain 
breaks or rupture.
  (j) Authorization of Appropriations.--There are authorized to 
be appropriated to carry out this section $10,000,000 for 
fiscal year 2005, $13,000,000 for fiscal year 2006, $15,000,000 
for fiscal year 2007, $8,000,000 for fiscal year 2008, and 
$4,000,000 for fiscal year 2009.

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  PART R--STROKE EDUCATION, INFORMATION, AND DATA COLLECTION PROGRAMS

SEC. 399AA. STROKE PREVENTION AND EDUCATION CAMPAIGN.

  (a) In General.--The Secretary shall carry out an education 
and information campaign to promote stroke prevention and 
increase the number of stroke patients who seek immediate 
treatment.
  (b) Authorized Activities.--In implementing the education and 
information campaign under subsection (a), the Secretary may--
          (1) make public service announcements about the 
        warning signs of stroke and the importance of treating 
        stroke as a medical emergency;
          (2) provide education regarding ways to prevent 
        stroke and the effectiveness of stroke treatment; and
          (3) carry out other activities that the Secretary 
        determines will promote prevention practices among the 
        general public and increase the number of stroke 
        patients who seek immediate care.
  (c) Measurements.--In implementing the education and 
information campaign under subsection (a), the Secretary 
shall--
          (1) measure public awareness before the start of the 
        campaign to provide baseline data that will be used to 
        evaluate the effectiveness of the public awareness 
        efforts;
          (2) establish quantitative benchmarks to measure the 
        impact of the campaign over time; and
          (3) measure the impact of the campaign not less than 
        once every 2 years or, if determined appropriate by the 
        Secretary, at shorter intervals.
  (d) No Duplication of Effort.--In carrying out this section, 
the Secretary shall avoid duplicating existing stroke education 
efforts by other Federal Government agencies.
  (e) Consultation.--In carrying out this section, the 
Secretary may consult with organizations and individuals with 
expertise in stroke prevention, diagnosis, treatment, and 
rehabilitation.

SEC. 399BB. PAUL COVERDELL NATIONAL ACUTE STROKE REGISTRY AND 
                    CLEARINGHOUSE.

  The Secretary, acting through the Centers for Disease Control 
and Prevention, shall maintain the Paul Coverdell National 
Acute Stroke Registry and Clearinghouse by--
          (1) continuing to develop and collect specific data 
        points and appropriate benchmarks for analyzing care of 
        acute stroke patients;
          (2) collecting, compiling, and disseminating 
        information on the achievements of, and problems 
        experienced by, State and local agencies and private 
        entities in developing and implementing emergency 
        medical systems and hospital-based quality of care 
        interventions; and
          (3) carrying out any other activities the Secretary 
        determines to be useful to maintain the Paul Coverdell 
        National Acute Stroke Registry and Clearinghouse to 
        reflect the latest advances in all forms of stroke 
        care.

SEC. 399CC. STROKE DEFINITION.

  For purposes of this part, the term ``stroke'' means a 
``brain attack'' in which blood flow to the brain is 
interrupted or in which a blood vessel or aneurysm in the brain 
breaks or ruptures.

SEC. 399DD. AUTHORIZATION OF APPROPRIATIONS.

  There is authorized to be appropriated to carry out this part 
$5,000,000 for each of fiscal years 2005 through 2009.

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TITLE XII--TRAUMA CARE

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Part E--Miscellaneous Programs

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[SEC. 1251.  RESIDENCY TRAINING PROGRAMS IN EMERGENCY MEDICINE.

  [(a) In General.--The Secretary may make grants to public and 
nonprofit private entities for the purpose of planning and 
developing approved residency training programs in emergency 
medicine.
  [(b) Identification and Referral of Domestic Violence.--The 
Secretary may make a grant under subsection (a) only if the 
applicant involved agrees that training programs under 
subsection (a) will provide education and training in 
identifying and referring cases of domestic violence.
  [(c) Authorization of Appropriations.--For the purpose of 
carrying out this section, there is authorized to be 
appropriated $400,000 for each of the fiscal years 1993 through 
1995.]

SEC. 1251. MEDICAL PROFESSIONAL DEVELOPMENT IN ADVANCED STROKE AND 
                    TRAUMATIC INJURY TREATMENT AND PREVENTION.

  (a) Residency and Other Professional Training.--The Secretary 
may make grants to public and nonprofit entities for the 
purpose of planning, developing, and enhancing approved 
residency training programs and other professional training for 
appropriate health professions in emergency medicine, including 
emergency medical services professionals, to improve stroke and 
traumatic injury prevention, diagnosis, treatment, and 
rehabilitation.
  (b) Continuing Education on Stroke and Traumatic Injury.--
          (1) Grants.--The Secretary, acting through the 
        Administrator of the Health Resources and Services 
        Administration, may make grants to qualified entities 
        for the development and implementation of education 
        programs for appropriate health care professionals in 
        the use of newly developed diagnostic approaches, 
        technologies, and therapies for health professionals 
        involved in the prevention, diagnosis, treatment, and 
        rehabilitation of stroke or traumatic injury.
          (2) Distribution of grants.--In awarding grants under 
        this subsection, the Secretary shall give preference to 
        qualified entities that will train health care 
        professionals that serve areas with a significant 
        incidence of stroke or traumatic injuries.
          (3) Application.--A qualified entity desiring a grant 
        under this subsection shall submit to the Secretary an 
        application at such time, in such manner, and 
        containing such information as the Secretary may 
        require, including a plan for the rigorous evaluation 
        of activities carried out with amounts received under 
        the grant.
          (4) Definitions.--For purposes of this subsection:
                  (A) The term ``qualified entity'' means a 
                consortium of public and private entities, such 
                as universities, academic medical centers, 
                hospitals, and emergency medical systems that 
                are coordinating education activities among 
                providers serving in a variety of medical 
                settings.
                  (B) The term ``stroke'' means a ``brain 
                attack'' in which blood flow to the brain is 
                interrupted or in which a blood vessel or 
                aneurysm in the brain breaks or ruptures.
  (c) Report.--Not later than 1 year after the allocation of 
grants under this section, the Secretary shall submit to the 
Committee on Health, Education, Labor, and Pensions of the 
Senate and the Committee on Energy and Commerce of the House of 
Representatives a report on the results of activities carried 
out with amounts received under this section.
  (d) Authorization of Appropriations.--There is authorized to 
be appropriated to carry out this section $4,000,000 for each 
of fiscal years 2005 through 2009. The Secretary shall 
equitably allocate the funds authorized to be appropriated 
under this section between efforts to address stroke and 
efforts to address traumatic injury.

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