[Senate Report 108-59]
[From the U.S. Government Publishing Office]



                                                       Calendar No. 123
108th Congress                                                   Report
                                 SENATE
 1st Session                                                     108-59

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



 
        TRAUMA CARE SYSTEMS PLANNING AND DEVELOPMENT ACT OF 2003

                                _______
                                

                  June 9, 2003.--Ordered to be printed

                                _______
                                

    Mr. Gregg, from the Committee on Health, Education, Labor, and 
                   Pensions, submitted the following

                              R E P O R T

                         [To accompany S. 239]

    The Committee on Health, Education, Labor, and Pensions, to 
which was referred the bill (S. 239) to amend the Public Health 
Service Act to add requirements regarding trauma care, and for 
other purposes, having considered the same, reports favorably 
thereon without amendment and recommends that the bill do pass.

                                CONTENTS

                                                                   Page
  I. Purpose and need for legislation.................................1
 II. Summary..........................................................2
III. History of legislation and votes in committee....................3
 IV. Explanation of bill and committee views..........................3
  V. Cost estimate and unfunded mandate statement.....................4
 VI. Regulatory impact statement......................................6
VII. Application of law to the legislative branch.....................6
VIII.Section-by-section analysis......................................6

 IX. Changes in existing law..........................................7

                  I. Purpose and Need for Legislation

    The purpose of the ``Trauma Care Systems Planning and 
Development Act of 2003'' is to assist State governments in the 
development, implementation, and improvement of statewide and 
regional systems of trauma care. By providing incentives to 
States to establish well-coordinated systems, severely injured 
individuals can receive specialized, high quality care as 
rapidly as possible following their injury. Experience has 
proven that death and disability for severely injured patients 
are both reduced dramatically when definitive care is provided 
within the so-called ``golden hour'' following their injury.
    Trauma is the leading killer of Americans up to age 34. 
Every year, more than 150,000 Americans die from traumatic 
injuries, many of which result from motor vehicle collisions, 
violence and falls. Given the events of September 11, 2001, and 
the nation's renewed focus on enhancing disaster preparedness, 
it is critical that the Federal Government increase its 
commitment to strengthening Title XII programs governing trauma 
care system planning and development.
    Survival among severely injured patients requires 
specialist care delivered promptly and in a coordinated manner. 
Care begins at the scene of injury, continues through emergency 
transport to the trauma center, intensive care unit, hospital 
floor, and ultimately to rehabilitation. Optimal acute care 
depends on technical expertise and coordination between teams 
of providers, including first responders, trauma center teams, 
acute care and rehabilitative care teams.
    A trauma care system is an organized approach to 
facilitating and coordinating a multidisciplinary system 
response to severely injured patients. It is inclusive of 
injury prevention, emergency department care, surgical 
interventions, intensive and general surgical in-hospital care, 
rehabilitative services, along with social services and support 
groups that enable the patient to return to society at the most 
productive level possible.
    Research has shown that functioning trauma systems can 
prevent death and disability resulting from trauma. For 
example, the establishment of an effective trauma system in San 
Diego County, CA was credited with reducing the proportion of 
preventable fatalities out of all deaths from 13.6 percent to 
2.7 percent. It is estimated that at least 25,000 deaths due to 
trauma can be prevented every year through the proper 
preventive, acute and rehabilitative care that trauma care 
systems can provide.
    Trauma care and emergency medical services systems are an 
integral component of our nation's health and public health 
infrastructure and an important public safety resource in all 
States. Throughout the U.S., trauma systems face ongoing and 
increasing challenges of both natural and man-made disasters.
    Strong Federal support for Title XII and the goals of the 
``Trauma Care Systems Planning and Development Act'' will help 
States and communities in need of improved infrastructure to 
provide effective and efficient care to severely injured 
patients.

                              II. Summary

    This legislation reauthorizes Title XII of the Public 
Health Service Act for a period of 5 years; doubles the funding 
available for trauma system development under Parts A-C of 
Title XII for fiscal year 2004, from $6 million to $12 million; 
and authorizes $750,000 for fiscal year 2004 and fiscal year 
2005 for the IOM study under Part E.
    First, the ``Trauma Care Systems Planning and Development 
Act of 2003'' improves the collection and analysis of trauma 
patient data with the goal of improving the overall system of 
care for these patients; second, at this time of increasing 
pressure on State budgets, the bill provides some relief to 
States in their matching requirements; third, the legislation 
provides a self-evaluation mechanism to assist States in 
assessing and improving their trauma care systems; fourth, it 
authorizes an Institute of Medicine (IOM) study on the state of 
trauma care and trauma research; and finally, it doubles the 
funding available for this program to allow additional States 
to participate.

           III. History of Legislation and Votes in Committee

    The ``Trauma Care Systems Planning and Development Act of 
1990,'' (PAL. 101-590) which created Title XII of the Public 
Health Service Act (PHS), was enacted to improve trauma care 
systems nationwide. From 1992 to 1994, the Health Resources and 
Services Administration (HRSA) administered the Federal funds 
to execute the responsibilities specified in the Act. The 
program's authority expired in 1995 and funding was 
discontinued. Title XII was reauthorized in 1998 for fiscal 
year 2000 through fiscal year 2002 in PAL. 105-392, the 
``Health Professions Partnership Act of 1998'' and funding re-
initiated in fiscal year 2001.
    During the first session of the 108th Congress, S. 239, the 
Trauma Care Systems Planning and Development Act of 2003, was 
introduced January 29th, 2003, to reauthorize the program. The 
Committee on Health, Education, Labor, and Pensions reported 
the bill favorably without amendment on February 12, 2003.

              IV. Explanation of Bill and Committee Views

    The bill has a variety of provisions, the explanation of 
and committee views on which follow below:
    The Clearinghouse on Trauma Care and Emergency Medical 
Services was authorized in previous legislation but never 
established at the Department. As a result, the committee 
collapsed clearinghouse functions into the general trauma care 
program.
    The bill adds a provision to an existing program for 
improving trauma care in rural areas that would increase 
coordination of State trauma systems with EMS operations in 
rural areas of the State. In rural areas, the barriers to 
coordination between first responders and State trauma systems 
may be greater. The committee expects that this change to the 
existing program will help to overcome some of those barriers.
    The bill reduces the States' contribution to the Federal 
matching requirement. It is hoped that this reduction will 
provide some relief to States and encourage more States to 
further develop their trauma care systems. The committee 
believes that although the Federal Government should provide 
assistance in ensuring the availability of quality trauma care 
for Americans, each State should be responsible for developing 
and maintaining a trauma care system that is tailored to its 
own needs. The revised matching requirement sustains the policy 
that the State investment in trauma care exceed the Federal 
contribution.
    It is critical that State trauma care systems coordinate 
well with other State-based health emergency systems, such as 
the bioterrorism and hospital preparedness systems. The bill 
adds a requirement for such coordination with State 
preparedness efforts.
    The bill requests an Institute of Medicine report on the 
status of the nation's trauma care and trauma care systems. The 
committee expects that this report will be important in 
properly evaluating trauma care systems and identifying 
priorities for trauma research in the future.
    The bill updates and revises the existing provision for the 
Secretary, acting through the Director of the NIH, to establish 
a comprehensive program of trauma research.

            V. Cost Estimate and Unfunded Mandate Statement

                                     U.S. Congress,
                               Congressional Budget Office,
                                    Washington, DC, March 13, 2003.
Hon. Judd Gregg,
Chairman, Committee on Health, Education, Labor, and Pensions, U.S. 
        Senate, Washington, DC.
    Dear Mr. Chairman: The Congressional Budget Office has 
prepared the enclosed cost estimate for S. 239, the Trauma Care 
Systems Planning and Development Act of 2003.
    If you wish further details on this estimate, we will be 
pleased to provide them. The CBO staff contact is Alexis 
Ahlstrom.
            Sincerely,
                                       Douglas Holtz-Eakin,
                                                          Director.
    Enclosure.

S. 239--Trauma Care System Planning and Development Act of 2003

    Summary: S. 239 would amend the Public Health Service Act 
to reauthorize the emergency services and trauma care programs 
administered by the Health Resources and Services 
Administration (HRSA). Those programs include grants to states 
for the development of trauma care systems, an emergency care 
residency training program, and a traumatic brain injury 
demonstration project. S. 239 also would require HRSA to 
contract for a study on trauma care and trauma research.
    Assuming the appropriation of the necessary amounts 
(including annual adjustments for anticipated inflation), CBO 
estimates that implementing S. 239 would cost $4 million in 
2004 and $71 million over the 2004-2008 period. The legislation 
would not affect direct spending or receipts.
    The bill contains no intergovernmental or private-sector 
mandates as defined in the Unfunded Mandates Reform Act (UMRA) 
and would impose no costs on state, local, or tribal 
governments.
    Estimated cost to the Federal Government: The estimated 
budgetary impact of S. 239 is shown in the following table. The 
costs of this legislation fall within budget function 550 
(health).

----------------------------------------------------------------------------------------------------------------
                                                                  By fiscal year, in millions of dollars--
                                                           -----------------------------------------------------
                                                              2003     2004     2005     2006     2007     2008
----------------------------------------------------------------------------------------------------------------
                                        SPENDING SUBJECT TO APPROPRIATION

Spending Under Current Law:
    Estimated Authorization Level \1\.....................       13       10       10        0        0        0
    Estimated Outlays.....................................       10       11       10        7        2        1
Proposed Changes: \2\
    Estimated Authorization Level.........................        0       13       13       23       23       24
    Estimated Outlays.....................................        0        4       10       15       20       22
Spending Under S. 239:
    Estimated Authorization Level \1\.....................       13       23       23       23       23       24
    Estimated Outlays.....................................       10       15       20       22       23       23
----------------------------------------------------------------------------------------------------------------
\1\ The 2003 level is the amount appropriated for that year for the Trauma/Emergency Medical Systems program.
\2\ Including adjustments for anticipated inflation, the estimated outlay changes would total $71 million over
  the 2004-2008 period. Without such adjustments, the five-year total would be $68 million.

    Basis of estimate: S. 239 would reauthorize three trauma-
related programs and would require HRSA to contract for a study 
on the current state of trauma care. Assuming the appropriation 
of the necessary amounts, CBO estimates that implementing S. 
239 would cost $4 million in 2004 and $71 million over the 
2004-2008 period.
    HRSA currently administers grants to states for the 
planning, development, and improvement of trauma centers and 
systems and maintains a clearinghouse on trauma care. S. 239 
would authorize the appropriation of $12 million in 2004 and 
such sums as necessary through 2008 for those activities.
    The planning grant part of that program provides federal 
matching payments to funds spent by states. Under current law, 
the federal government does not require contribution of state 
funds in the first year, but requires a matching payment of $1 
for every $1 of state spending in the second year, and a $3 for 
every $1 subsequently. Under the bill, states would receive 
grants without the contribution of their own funds for the 
first two years. In the third year, the federal government 
would provide a matching payment of $1 for every $1 of state 
spending. In subsequent years, the federal government would 
provide a matching payment of $1 for every $2 of state 
spending.
    State participation under the current, less-generous 
program is very high. States in 2002 were not required to 
contribute any matching funds, and used grant monies from HRSA 
to do needs assessments and to plan for future uses of grant 
money. Although states will have to contribute $1 for every $1 
they receive in federal grants under current law in 2003, HRSA 
believes that state participation in 2003 will be similar to 
the level in 2002. Since the bill would provide for a more-
generous program (i.e., lower state-matching requirements), we 
expect that participation would remain high under S. 239.
    The authorization level for 2004 under S. 239 for this 
program would be almost four times higher than the 2003 
appropriation level of $3.5 million. Based on current state 
spending for the planning grant program and on discussions with 
HRSA about strong interest by states for participation in this 
program. CBO estimates that state contributions toward these 
grants would be sufficient to obligate the proposed level of 
appropriation in S. 239. Based on historical spending patterns 
for this program, CBO estimates that implementing this 
provision would cost a little less than $4 million in 2004 and 
$48 million over the 2004-2008 period.
    S. 239 also would reauthorize a residency training program 
in emergency medicine for the 2004-2008 period. The bill would 
authorize $400,000 each year for grants to public and private 
nonprofit entities for the development of residency programs 
with an emphasis on treatment and referral of domestic violence 
cases. CBO estimates that implementing this provision would 
cost $2 million over the 2004-2008 period.
    Under current law, HRSA is administering a demonstration 
project that provides grants to states to improve access to 
health and other services in brain injury cases. S. 239 would 
reauthorize this program and remove its designation as a 
demonstration project. The bill would authorize such sums as 
necessary. Based on historical spending for the demonstration 
program and assuming the appropriation of the necessary 
amounts, CBO estimates that implementing this provision would 
cost $3 million in 2006 and $20 million over the 2006-2008 
period. (This provision would have no effect on discretionary 
spending in 2004 or 2005 because the program is authorized 
through 2005 under current law.)
    S. 239 would require the Secretary of Health and Human 
Services to contract with the Institutes of Medicine or a 
similar entity to conduct a study on trauma care. The bill 
would authorize the appropriation of $750,000 in both 2004 and 
2005. Based on spending for similar activities, CBO estimates 
that implementing this provision would cost $1.5 million over 
the 2004-2006 period.
    Intergovernmental and private-sector impact: The bill 
contains no intergovernmental or private-sector mandates as 
defined in UMRA and would impose no costs on state, local, or 
tribal governments. The bill would reauthorize and increase 
authorized funding for a grant program designed to improve the 
quality of trauma care systems. States that choose to apply for 
those grants would have to provide matching funds, but any 
costs they incur would be voluntary.
    Estimated prepared by: Federal Costs: Alexis Ahlstrom; 
Impact on State, Local, and Tribal Governments: Leo Lex; and 
Impact on the Private Sector: David Auerbach.
    Estimate approved by: Peter H. Fontaine, Deputy Assistant 
Director for Budget Analysis.

                    VI. Regulatory Impact Statement

    In accordance with paragraph 11(b) of rule XXVI of the 
Standing Rules of the Senate, the committee has determined that 
there will be minimal increases in the regulatory burden 
imposed by this bill.

           VII. Application of Law to the Legislative Branch

    The committee has determined that there is no impact of 
this law on the Legislative Branch.

                   VIII. Section-by-Section Analysis


Section 1. Short title

    ``Trauma Care Systems Planning and Development Act of 
2003''.

Section 2. Findings

    This Section makes certain findings regarding the cost and 
burden of trauma and the importance of trauma care systems.

Section 3. Amendments

    This Section reauthorizes the current grant program to 
enable a State to develop, implement, and maintain statewide 
trauma care systems. This Section collapses the duties of the 
Clearinghouse into the general program description and 
authorizes the Secretary, acting through HRSA, to promote the 
reporting and collection of trauma data in a consistent, 
standardized manner and strikes it from its original position 
in the statute. This Section also eliminates authorization for 
the Clearinghouse on Trauma Care and Emergency Medical 
Services.
    This Section authorizes the Secretary to make grants for 
programs for improving trauma care in rural areas. Grants are 
authorized to increase coordination of emergency medical 
services (EMS) in rural areas with statewide trauma systems, 
under existing rural grant programs.
    The Section requires matching funds for fiscal years 
subsequent to first fiscal year of payments. The Section amends 
the requirement of State matching funds in the following 
manner: first fiscal year--no match; second fiscal year--$1 
State: $1 Federal; third fiscal year--$1 State: $1 Federal; 
fourth fiscal year--$2 State: $1 Federal; and fifth fiscal 
year--$2 State: $1 Federal.
    Section 3 promotes standardized trauma data collection 
requirements under the trauma care component of the State plan 
for EMS and promotes coordination with State disaster emergency 
planning and bioterrorism hospital preparedness planning under 
the trauma care component of the State plan for EMS. Section 3 
also requests the Secretary to update the model trauma care 
plan.
    This Section authorizes the appropriation of $12,000,000 
for fiscal year 2004 and such sums as may be necessary for 
fiscal years 2005 through 2008.
    This Section requests an Institute of Medicine study on the 
state of trauma care and trauma research and authorizes 
$750,000 for fiscal years 2004 and 2005 for such study.

                      IX. Changes in Existing Law

    In compliance with rule XXVI paragraph 12 of the Standing 
Rules of the Senate, the following provides a print of the 
statute or the part or section thereof to be amended or 
replaced (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

           *       *       *       *       *       *       *



TRAUMA CARE SYSTEMS PLANNING AND DEVELOPMENT ACT OF 2003

           *       *       *       *       *       *       *



                         TITLE XII--TRAUMA CARE


Part A--General Authority and Duties of Secretary

           *       *       *       *       *       *       *



SEC. 1201. ESTABLISHMENT.

    (a) In General.--The Secretary, acting through the 
Administrator of the Health Resources and Services 
Administration, shall, with respect to trauma care--
          (1) conduct and support research, training, 
        evaluations, and demonstration projects;
          (2) foster the development of appropriate, modern 
        systems of such care through the sharing of information 
        among agencies and individuals involved in the study 
        and provision of such care;
          (3) collect, compile, and disseminate information on 
        the achievements of, and problems experienced by, State 
        and local agencies and private entities in providing 
        trauma care and emergency medical services and, in so 
        doing, give special consideration to the unique needs 
        of rural areas;
          [(3)] (4) provide to State and local agencies 
        technical assistance to enhance each State's capability 
        to develop, implement, and sustain the trauma care 
        component of each State's plan for the provision of 
        emergency medical services; [and]
          [(4)] (5) sponsor workshops and conferences; and
          (6) promote the collection and categorization of 
        trauma data in a consistent and standardized manner.
    (b) Grants, Cooperative Agreements, and Contracts.--The 
Secretary acting through the Administrator of the Health 
Resources and Services Administration, may make grants, and 
enter into cooperative agreements and contracts, for the 
purpose of carrying out subsection (a).
    [(c) Administration.--The Administrator of the Health 
Resources and Services Administration shall ensure that this 
title is administered by the Division of Trauma and Emergency 
Medical Systems within such Administration. Such Division shall 
be headed by a director appointed by the Secretary from among 
individuals who are knowledgeable by training or experience in 
the development and operation of trauma and emergency medical 
systems.]

           *       *       *       *       *       *       *


[SEC. 1202. CLEARINGHOUSE ON TRAUMA CARE AND EMERGENCY MEDICAL 
                    SERVICES.

    [(a) Establishment.--The Secretary shall by contract 
provide for the establishment and operation of a National 
Clearinghouse on Trauma Care and Emergency Medical Services 
(hereafter in this section referred to as the 
``Clearinghouse'').
    [(b) Duties.--The Clearinghouse shall--
          [(1) foster the development of appropriate, modern 
        trauma care and emergency medical services (including 
        the development of policies for the notification of 
        family members of individuals involved in medical 
        emergencies) through the sharing of information among 
        agencies and individuals involved in planning, 
        furnishing, and studying such services and care;
          [(2) collect, compile, and disseminate information on 
        the achievements of, and problems experienced by, State 
        and local agencies and private entities in providing 
        trauma care and emergency medical services and, in so 
        doing, give special consideration of the unique needs 
        of rural areas;
          [(3) provide technical assistance relating to trauma 
        care and emergency medical services to State and local 
        agencies; and
          [(4) sponsor workshops and conferences on trauma care 
        and emergency medical services.
    [(c) Fees and Assessments.--A contract entered into by the 
Secretary under this section may provide that the Clearinghouse 
charge fees or assessments in order to defray, and beginning 
with fiscal year 1992, to cover, the costs of operating the 
Clearinghouse.]

 SEC. [1203.] 1202. ESTABLISHMENT OF PROGRAMS FOR IMPROVING TRAUMA CARE 
                    IN RURAL AREAS.

    (a) In General.--*  *  *

           *       *       *       *       *       *       *

          (2) by developing model curricula, such as advanced 
        trauma life support, for training emergency medical 
        services personnel, including first responders, 
        emergency medical technicians, emergency nurses and 
        physicians, and paramedics--
                  (A) *  *  *
                  (B) *  *  *

           *       *       *       *       *       *       *

          (4) by developing innovative protocols and agreements 
        to increase access to prehospital care and equipment 
        necessary for the transportation of seriously injured 
        patients to the appropriate facilities; [and]
          (5) by evaluating the effectiveness of protocols with 
        respect to emergency medical services and systems[.]; 
        and
          (6) by increasing communication and coordination with 
        State trauma systems.

           *       *       *       *       *       *       *


SEC. 1212. REQUIREMENT OF MATCHING FUNDS FOR FISCAL YEARS SUBSEQUENT TO 
                    FIRST FISCAL YEAR OF PAYMENTS.

    (a) Non-Federal Contributions.--
          (1) In general.--The Secretary may not make payments 
        under section 1211(a) unless the State involved agrees, 
        with respect to the costs described in paragraph (2), 
        to make available non-Federal contributions (in cash or 
        in kind under subsection (b)(1)) toward such costs in 
        an amount equal to--
                  (A) for the second fiscal year of such 
                payments to the State, not less than $1 for 
                each $1 of Federal funds provided in such 
                payments for such fiscal year; [and]
                  [(B) for any subsequent fiscal year of such 
                payments to the State, not less than $3 for 
                each $1 of Federal funds provided in such 
                payments for such fiscal year.]
                  (B) for the third fiscal year of such 
                payments to the State, not less than $1 for 
                each $1 of Federal funds provided in such 
                payments for such fiscal year;
                  (C) for the fourth fiscal year of such 
                payments to the State, not less than $2 for 
                each $1 of Federal funds provided in such 
                payments for such fiscal year; and
                  (D) for the fifth fiscal year of such 
                payments to the State, not less than $2 for 
                each $1 of Federal funds provided in such 
                payments for such fiscal year.

           *       *       *       *       *       *       *

    (b) Determination of Amount of Non-Federal Contribution.--
With respect to compliance with subsection (a) as a condition 
of receiving payments under section 1211(a)--
          (1) a State may make the non-Federal contributions 
        required in such subsection in cash or in kind, fairly 
        evaluated, including plant, equipment, or services; and
          (2) the Secretary may not, in making a determination 
        of the amount of non-Federal contributions, include 
        amounts provided by the Federal Government or services 
        assisted or subsidized to any significant extent by the 
        Federal Government[; and].
          [(3) the Secretary shall, in making such a 
        determination, include only non-Federal contributions 
        in excess of the amount of non-Federal contributions 
        made by the State during fiscal year 1990 toward--
                  [(A) the costs of providing trauma care in 
                the State; and
                  [(B) the costs of improving the quality and 
                availability of emergency medical services in 
                rural areas of the State.]

SEC. 1213. REQUIREMENTS WITH RESPECT TO CARRYING OUT PURPOSE OF 
                    ALLOTMENTS.

    (a) Trauma Care Modifications to State Plan for Emergency 
Medical Services.--* * *
          (1) * * *
          (2) * * *
          (3) subject to subsection (b), contains nationally 
        recognized standards and requirements for the 
        designation of level I and level II trauma centers, and 
        in the case of rural areas level III trauma centers 
        (including trauma centers with specified capabilities 
        and expertise in the care of the pediatric trauma 
        patient), by such entity, including standards and 
        requirements for--
                  (A) the number and types of trauma patients 
                for whom such centers must provide care in 
                order to ensure that such centers will have 
                sufficient experience and expertise to be able 
                to provide quality care for victims of injury;

           *       *       *       *       *       *       *

          (5) subject to subsection (b), contains nationally 
        recognized standards and requirements for medically 
        directed triage and transport of severely injured 
        children to designated trauma centers with specified 
        capabilities and expertise in the care of the pediatric 
        trauma patient;
          (6) [specifies procedures for the evaluation of 
        designated] utilizes a program with procedures for the 
        evaluation of trauma centers (including trauma centers 
        described in paragraph (5)) and trauma care systems;
          (7) provides for the establishment and collection of 
        data in accordance with data collection requirements 
        developed in consultation with surgical, medical, and 
        nursing specialty groups, State and local emergency 
        medical services directors, and other trained 
        professionals in trauma care from each designated 
        trauma center in the State of a central data reporting 
        and analysis system--
                  (A) to identify the number of severely 
                injured trauma patients and the number of 
                deaths from trauma within regional trauma care 
                systems in the State;

           *       *       *       *       *       *       *

                  (F) to identify patients transferred within a 
                regional trauma system, including reasons for 
                such transfer and the outcomes of such 
                patients;

           *       *       *       *       *       *       *

          (9) provides for appropriate transportation and 
        transfer policies to ensure the delivery of patients to 
        designated trauma centers and other facilities within 
        and outside of the jurisdiction of such system, 
        including policies to ensure that only individuals 
        appropriately identified as trauma patients are 
        transferred to designated trauma centers, and to 
        provide periodic reviews of the transfers and the 
        auditing of such transfers that are determined to be 
        appropriate;
          (10) coordinates planning for trauma systems with 
        State disaster emergency planning and bioterrorism 
        hospital preparedness planning;
          [(10)] (11) conducts public education activities 
        concerning injury prevention and obtaining access to 
        trauma care; and
          [(11)] (12) with respect to the requirements 
        established in this subsection, provides for 
        coordination and cooperation between the State and any 
        other State with which the State shares any standard 
        metropolitan statistical area.
    (b) Certain Standards With Respect to Trauma Care Center 
and System.--
          (1) In general.--The Secretary may not make payments 
        under section 1211(a) for a fiscal year unless the 
        State involved agrees that, in carrying out paragraphs 
        (3) through (5) of subsection (a), the State will adopt 
        standards for the designation of trauma centers, and 
        for triage, transfer, and transportation policies, and 
        that the State will, in adopting such standards--
                  (A) take into account national standards 
                [concerning such] that outline resources for 
                optimal care of the injured patient;

           *       *       *       *       *       *       *

                  (D) beginning in fiscal year [1992] 2004, 
                take into account the model plan described in 
                subsection (c).

           *       *       *       *       *       *       *

          (3) Approval by secretary.--The Secretary may not 
        make payments under section 1211(a) to a State if the 
        Secretary determines that--
                  (A) in the case of payments for fiscal year 
                [1991] 2004 and subsequent fiscal years, the 
                State has not taken into account national 
                standards, including those of the American 
                College of Surgeons, the American College of 
                Emergency Physicians and the American Academy 
                of Pediatrics, in adopting standards under this 
                subsection; or
                  (B) in the case of payments for fiscal year 
                [1992] 2004 and subsequent fiscal years, the 
                State has not, in adopting such standards, 
                taken into account the model plan developed 
                under subsection (c).
    (c) Model Trauma Care Plan.--Not later than 1 year after 
the date of the enactment of the Trauma Care Systems Planning 
and Development Act of [1990, the Secretary shall develop a 
model plan] 2003, the Secretary shall update the model plan for 
the designation of trauma centers and for triage, transfer and 
transportation policies that may be adopted for guidance by the 
State. Such plan shall--

           *       *       *       *       *       *       *


SEC. 1214. REQUIREMENT OF SUBMISSION TO SECRETARY OF TRAUMA PLAN AND 
                    CERTAIN INFORMATION.

    (a) Trauma Plan.--
          (1) In general.--For fiscal year [1991] 2004 and 
        subsequent fiscal years, the Secretary may not make 
        payments under section 1211(a) unless, subject to 
        paragraph (2), the State involved submits to the 
        Secretary the trauma care component of the State plan 
        for the provision of emergency medical services that 
        includes changes and improvements made and plans to 
        address deficiencies identified.
          (2) Interim plan or description of efforts.--For 
        fiscal year [1991] 2004, if a State has not completed 
        the trauma care component of the State plan described 
        in paragraph (1), the State may provide, in lieu of a 
        completed such component, an interim component or a 
        description of efforts made toward the completion of 
        the component.

           *       *       *       *       *       *       *


SEC. 1215. RESTRICTIONS ON USE OF PAYMENTS.

    (a) In General.--The Secretary may not, except as provided 
in subsection (b), make payments under section 1211(a) for a 
fiscal year unless the State involved agrees that the payments 
will not be expended--
          (1) subject to section 1233, for any purpose other 
        than developing, implementing, and monitoring the 
        modifications required by section 1211(b) to be made to 
        the State plan for the provision of emergency medical 
        services[.];

           *       *       *       *       *       *       *


[SEC. 1216. REQUIREMENT OF REPORTS BY STATES.

    [(a) In General.--The Secretary may not make payments under 
section 1211(a) for a fiscal year unless the State involved 
agrees to prepare and submit to the Secretary an annual report 
in such form and containing such information as the Secretary 
determines (after consultation with the States) to be necessary 
for--
          [(1) securing a record and a description of the 
        purposes for which payments received by the State 
        pursuant to such section were expended and of the 
        recipients of such payments; and
          [(2) determining whether the payments were expended 
        in accordance with the purpose of the program involved.
    [(b) Availability to Public of Reports.--The Secretary may 
not make payments under section 1211(a) unless the State 
involved agrees that the State will make copies of the report 
described in subsection (a) available for public inspection.
    [(c) Evaluations by Comptroller General.--The Comptroller 
General of the United States shall evaluate the expenditures by 
States of payments under section 1211(a) in order to assure 
that expenditures are consistent with the provisions of this 
part, and not later than December 1, 1994, prepare and submit 
to the Committee on Energy and Commerce of the House of 
Representatives and the Committee on Labor and Human Resources 
of the Senate a report concerning such evaluation.]

SEC. 1216. [RESERVED].

           *       *       *       *       *       *       *


SEC. 1222. REPORT BY SECRETARY.

    Not later than October 1, [1995] 2006, the Secretary shall 
report to the appropriate committees of Congress on the 
activities of the States carried out pursuant to section 1211. 
Such report shall include an assessment of the extent to which 
Federal and State efforts to develop systems of trauma care and 
to designate trauma centers have reduced the incidence of 
mortality, and the incidence of permanent disability, resulting 
from trauma. Such report may include any recommendations of the 
Secretary for appropriate administrative and legislative 
initiatives with respect to trauma care.

           *       *       *       *       *       *       *


SEC. 1232. FUNDING.

    [(a) Authorization of Appropriations.--For the purpose of 
carrying out parts A and B, there are authorized to be 
appropriated $6,000,000 for fiscal year 1994, and such sums as 
may be necessary for each of the fiscal years 1995 through 
2002.]
    (a) Authorization of Appropriations.--For the purpose of 
carrying out parts A and B, there are authorized to be 
appropriated $12,000,000 for fiscal year 2004, and such sums as 
may be necessary for each of the fiscal years 2005 through 
2008.
    (b) Allocations of Funds by Secretary.--
          (1) General authority.--For the purpose of carrying 
        out part A, the Secretary shall make available 10 
        percent of the amounts appropriated for a fiscal year 
        under subsection (a).
          (2) Rural grants.--For the purpose of carrying out 
        section [1204] 1202, the Secretary shall make available 
        10 percent of the amounts appropriated for a fiscal 
        year under subsection (a).

           *       *       *       *       *       *       *


                    [Part E--Miscellaneous Programs]


                     Part E--Miscellaneous Programs

SEC. 1251. RESIDENCY TRAINING PROGRAMS IN EMERGENCY MEDICINE.

    (a) In General.--*  *  *

           *       *       *       *       *       *       *

    (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] 2004 through 2008.

           *       *       *       *       *       *       *


SEC. 1252. STATE GRANTS FOR [DEMONSTRATION] PROJECTS REGARDING 
                    TRAUMATIC BRAIN INJURY.

    (a) In General.--*  *  *

           *       *       *       *       *       *       *


SEC. 1254. INSTITUTE OF MEDICINE STUDY.

    (a) In General.--The Secretary shall enter into a contract 
with the Institute of Medicine of the National Academy of 
Sciences, or another appropriate entity, to conduct a study on 
the state of trauma care and trauma research.
    (b) Content.--The study conducted under subsection (a) 
shall--
          (1) examine and evaluate the state of trauma care and 
        trauma systems research (including the role of Federal 
        entities in trauma research) on the date of enactment 
        of this section, and identify trauma research 
        priorities;
          (2) examine and evaluate the clinical effectiveness 
        of trauma care and the impact of trauma care on patient 
        outcomes, with special attention to high-risk groups, 
        such as children, the elderly, and individuals in rural 
        areas;
          (3) examine and evaluate trauma systems development 
        and identify obstacles that prevent or hinder the 
        effectiveness of trauma systems and trauma systems 
        development;
          (4) examine and evaluate alternative strategies for 
        the organization, financing, and delivery of trauma 
        care within an overall systems approach; and
          (5) examine and evaluate the role of trauma systems 
        and trauma centers in preparedness for mass casualties.
    (c) Report.--Not later than 2 years after the date of 
enactment of this section, the Secretary shall submit to the 
appropriate committees of Congress a report containing the 
results of the study conducted under this section.
    (d) Authorization of Appropriations.--There is authorized 
to be appropriated to carry out this section $750,000 for each 
of fiscal years 2004 and 2005.

           *       *       *       *       *       *       *


            Part F--Interagency Program for Trauma Research


SEC. 1261. ESTABLISHMENT OF PROGRAM.

    (a) In General.--The Secretary, acting through the Director 
of the National Institutes of Health (in this section referred 
to as the ``Director''), shall establish a comprehensive 
program of [conducting basic and clinical research on trauma 
(in this section referred to as the ``Program''). The Program 
shall include research regarding the diagnosis, treatment, 
rehabilitation, and general management of trauma.] basic and 
clinical research on trauma (in this section referred to as the 
``Program''), including the prevention, diagnosis, treatment, 
and rehabilitation of trauma-related injuries.
    [(b) Plan for Program.--
          [(1) In general.--The Director, in consultation with 
        the Trauma Research Interagency Coordinating Committee 
        established under subsection (g), shall establish and 
        implement a plan for carrying out the activities of the 
        Program, including the activities described in 
        subsection (d). All such activities shall be carried 
        out in accordance with the plan. The plan shall be 
        periodically reviewed, and revised as appropriate.
          [(2) Submission to congress.--Not later than December 
        1, 1993, the Director shall submit the plan required in 
        paragraph (1) to the Committee on Energy and Commerce 
        of the House of Representatives, and to the Committee 
        on Labor and Human Resources of the Senate, together 
        with an estimate of the funds needed for each of the 
        fiscal years 1994 through 1996 to implement the plan.]
    (b) Plan for Program.--The Director shall establish and 
implement a plan for carrying out the activities of the 
Program, taking into consideration the recommendations 
contained within the report of the NIH Trauma Research Task 
Force. The plan shall be periodically reviewed, and revised as 
appropriate.

           *       *       *       *       *       *       *

    (d) Certain Activities of Program.--The Program shall 
include--
          (1) * * *

           *       *       *       *       *       *       *

          (4) the authority to make awards of grants or 
        contracts to public or nonprofit private entities for 
        the conduct of basic and applied research regarding 
        traumatic brain injury, which research may include--
                  (A) the development of new methods and 
                modalities for the more effective diagnosis, 
                measurement of degree of brain injury, post-
                injury monitoring and prognostic assessment of 
                head injury for acute, subacute and later 
                phases of care;
                  (B) the development, modification and 
                evaluation of therapies that retard, prevent or 
                reverse brain damage after [acute head injury] 
                traumatic brain injury, that arrest further 
                deterioration following injury and that provide 
                the restitution of function for individuals 
                with long-term injuries;

           *       *       *       *       *       *       *

                  [(D) the development of programs that 
                increase the participation of academic centers 
                of excellence in [head] traumatic brain injury 
                treatment and rehabilitation research and 
                training; and

           *       *       *       *       *       *       *

    [(g) Coordinating Committee.--
          [(1) In general.--There shall be established a Trauma 
        Research Interagency Coordinating Committee (in this 
        section referred to as the ``Coordinating Committee'').
          [(2) Duties.--The Coordinating Committee shall make 
        recommendations regarding--
                  [(A) the activities of the Program to be 
                carried out by each of the agencies represented 
                on the Committee and the amount of funds needed 
                by each of the agencies for such activities; 
                and
                  [(B) effective collaboration among the 
                agencies in carrying out the activities.
          [(3) Composition.--The Coordinating Committee shall 
        be composed of the Directors of each of the agencies 
        that, under subsection (c), have responsibilities under 
        the Program, and any other individuals who are 
        practitioners in the trauma field as designated by the 
        Director of the National Institutes of Health.]
    [(h)] (g) Definitions.--For purposes of this section:
          (1) The term ``designated trauma center'' has the 
        meaning given such term in section 1231(1).
          (2) The term ``Director'' means the Director of the 
        National Institutes of Health.
          (3) The term ``trauma'' means any serious injury that 
        could result in loss of life or in significant 
        disability and that would meet pre-hospital triage 
        criteria for transport to a designated trauma center.
          (4) The term ``traumatic brain injury'' means an 
        acquired injury to the brain. Such term does not 
        include brain dysfunction caused by congenital or 
        degenerative disorders, nor birth trauma, but may 
        include brain injuries caused by anoxia due to trauma. 
        The Secretary may revise the definition of such term as 
        the Secretary determines necessary, after consultation 
        with States and other appropriate public or nonprofit 
        private entities.
    [(i)] (h) Authorization of Appropriations.--For the purpose 
of carrying out this section, there are authorized to be 
appropriated such sums as may be necessary for each of the 
fiscal years [2001 through 2005] 2004 through 2008.

           *       *       *       *       *       *       *


                                
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