[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.
* * * * * * *