[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.
* * * * * * *
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.
* * * * * * *
TITLE XII--TRAUMA CARE
* * * * * * *
Part E--Miscellaneous Programs
* * * * * * *
[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.
* * * * * * *