[Senate Report 109-215]
[From the U.S. Government Publishing Office]



                                                       Calendar No. 359
109th Congress                                                   Report
                                 SENATE
 2d Session                                                     109-215
======================================================================
 
        TRAUMA CARE SYSTEMS PLANNING AND DEVELOPMENT ACT OF 2005

                                _______
                                

                February 2, 2006.--Ordered to be printed

                                _______
                                

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

                              R E P O R T

                         [To accompany S. 265]

    The Committee on Health, Education, Labor, and Pensions, to 
which was referred the bill (S. 265) 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 Committee Action......................3
 IV. Explanation of Bill and Committee Views..........................3
  V. Cost Estimate and Unfunded Mandate Statement.....................4
 VI. Application of Law to the Legislative Branch.....................6
VII. Regulatory Impact Statement......................................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 2005'' 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. 
Yet, according to the Centers for Disease Control (CDC), only 
one fourth of the United States' population lives in an area 
served by a trauma system.
    Trauma is the leading cause of death for Americans between 
the ages of 1 and 44 years and is among the top five causes of 
death in the general population of the United States. According 
to the CDC every year, more than 150,000 Americans die from 
traumatic injuries, many of which result from motor vehicle 
collisions, violence, and falls. Given 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.
    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 United States, trauma systems face 
ongoing and increasing challenges of both natural and man-made 
disasters. The National Center for Injury Prevention and 
Control reports studies showing that as many as 35 percent of 
trauma patient deaths could have been prevented if optimal 
acute care had been available.
    Strong Federal support for Title XII of the Public Health 
Service Act 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. A 1999 study in the Journal 
of Trauma, Injury, Infection and Critical Care reported that 
seriously injured patients have a 15 to 20 percent improved 
survival rate if the patients access a trauma system.

                              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 2006, from $6 million to $12 million; 
and authorizes $750,000 for fiscal year 2008 for an Institute 
of Medicine (IOM) study of trauma care systems.
    First, the ``Trauma Care Systems Planning and Development 
Act of 2005'' improves the collection and analysis of trauma 
patient data with the goal of improving the overall system of 
care for these patients. Second, the bill adjusts States 
matching requirements for Federal grant funding; third, the 
legislation provides a self-evaluation mechanism to assist 
States in assessing and improving their trauma care systems; 
and finally, it authorizes an IOM study on the state of trauma 
care and trauma research.

            III. History of Legislation and Committee Action

    The ``Trauma Care Systems Planning and Development Act of 
1990,'' (P.L. 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 P.L. 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 on January 29, 2003, to reauthorize the program. The 
Committee on Health, Education, Labor, and Pensions reported 
the bill favorably without amendment on February 12, 2003. The 
Senate passed the bill on July 1, 2003 by unanimous consent. 
The House received S. 239 from the Senate and referred it to 
the House Energy and Commerce Committee, Subcommittee on 
Health. No further action was taken during the 108th Congress.
    During the first session of the 109th Congress, S. 265, the 
Trauma Care Systems Planning and Development Act of 2005, was 
introduced February 2, 2005, to reauthorize the program. After 
accepting a substitute amendment offered by Senator Frist, the 
Committee on Health, Education, Labor, and Pensions reported 
the bill favorably by unanimous voice vote on February 9, 2005.

              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 bill reauthorizes and makes improvements to the Trauma 
Care Program under Title XII of the Public Health Service Act. 
This committee expects the program to continue to be 
administered by the Health Resources and Services 
Administration (HRSA). A Clearinghouse on Trauma Care and 
Emergency Medical Services was authorized in previous 
legislation but never established at the Department. As a 
result, the committee has collapsed clearinghouse functions 
into the general trauma care program.
    The bill reduces the States' contribution to the Federal 
matching requirement for grants under the Trauma Care Program. 
It is hoped that this reduction will enable some States to be 
able to participate in the program and encourage other 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 State investments in trauma care exceed the Federal 
contribution.
    The committee supports the Interagency Program for Trauma 
Research and strongly urges the NIH to continue with this 
important work to conduct basic and clinical research on 
trauma.
    The Senate bill as reported out of committee reauthorized 
the program through fiscal year 2009. However, the committee 
notes that this program would be more appropriately placed in 
Title IV of the Public Health Service Act which authorizes the 
National Institutes of Health (NIH) and also is under the 
committee's jurisdiction. The committee fully intends to 
actively pursue reauthorization of the NIH and plans to retain 
authority for the Interagency Program for Trauma Research as 
part of that effort.
    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 Emergency Medical 
Systems (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 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.

            V. Cost Estimate and Unfunded Mandate Statement

                                     U.S. Congress,
                               Congressional Budget Office,
                                      Washington, DC, May 27, 2005.
Hon. Mike Enzi,
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. 265, the Trauma Care 
Systems Planning and Development Act of 2005.
    If you wish further details on this estimate, we will be 
pleased to provide them. The CBO staff contact is Tim 
Gronniger.
            Sincerely,
                                       Douglas Holtz-Eakin,
                                                          Director.
    Enclosure.

S. 265--Trauma Care Systems Planning and Development Act of 2005

    Summary: S. 265 would amend the Public Health Service Act 
to authorize several 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 and an emergency 
care residency training program. S. 265 also would require HRSA 
to contract for a study on trauma care and trauma research.
    Assuming that the necessary amounts (including annual 
adjustments for anticipated inflation) are appropriated for 
fiscal years 2006 through 2009, CBO estimates that implementing 
S. 265 would cost $47 million over the 2006-2010 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). 
The bill would authorize and increase appropriations for grant 
programs 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 face would 
be incurred voluntarily.
    Estimated cost to the Federal Government: The estimated 
budgetary impact of S. 265 is shown in the following table. The 
costs of this legislation fall within budget function 550 
(health).


----------------------------------------------------------------------------------------------------------------
                                                                  By fiscal year, in millions of dollars--
                                                           -----------------------------------------------------
                                                              2005     2006     2007     2008     2009     2010
----------------------------------------------------------------------
                         SPENDING SUBJECT TO APPROPRIATION

Spending Under Current Law:
    Estimated Budget Authority \1\........................        3        0        0        0        0        0
    Estimated Outlays.....................................        3        2        1        0        0        0
Proposed Changes \2\ \3\
    Estimated Authorization Level.........................        0       13       13       13       13        0
    Estimated Outlays.....................................        0        4        9       13       13        9
Spending Under S. 265:
    Estimated Authorization Level \1\.....................        3       13       13       13       13        0
    EstImated Outlays.....................................        3        6       10       13       13        9
----------------------------------------------------------------------------------------------------------------
\1\ The 2005 level is the amount appropriated for that year.
\2\ The bill also would authorize funding for 2005, but this estimate assumes that no additional funds will be
  appropriated this year.
\3\ Including adjustments for anticipated inflation, the estimated outlay changes would total $47 million over
  the 2006-2010 period. Without such adjustments, the five-year total would be $46 million.

    Basis of estimate: S. 265 would authorize two 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. 
265 would cost $47 million over the 2006-2010 period.
    HRSA currently administers grants to states for the 
planning, development, and improvement of trauma centers and 
systems. S. 265 would authorize the appropriation of $12 
million in 2005 and such sums as necessary through 2009 for 
those activities. In 2005, $3 million was appropriated for 
those activities, although the authorization expired in 2004. 
For this estimate, CBO assumes that no additional funds will be 
appropriated for the current year.
    The planning grant part of that program provides federal 
matching payments to funds spent by states. Under prior law, 
the federal government did not require contribution of state 
funds in the first year, but required a matching payment of $1 
for every $1 of state spending in the second year, and a $3 
match for every $1 spent in subsequent years. In 2005, however, 
because the appropriation is not sufficient to fund that 
schedule of matching payments, HRSA is providing roughly equal 
amounts to each participating state.
    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 the fourth and 
fifth 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. The authorization level for 2005 under S. 
265 for this program would be four times higher than the 2005 
appropriation level of $3 million. Based on information 
provided by HRSA about states' trauma-planning activities and 
on historical spending patterns for this program, CBO estimates 
that the cost of implementing this provision would be $4 
million in 2006 and $46 million over the 2006-2010 period.
    S. 265 also would authorize a residency training program in 
emergency medicine. The bill would authorize $400,000 each year 
through 2009 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 $1.6 
million over the 2006-2009 period.
    S. 265 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 2005 and 
2006. Assuming the availability of appropriated funds, 
conducting the study could cost up to $1.5 million.
    Intergovernmental and private-sector impact: The bill 
contains no intergovemmental or private-sector mandates as 
defined in UMRA and would impose no costs on state, local, or 
tribal governments. The bill would authorize 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.
    Estimate prepared by: Federal costs: Tim Gronniger; impact 
on state, local, and tribal governments: Leo Lex; impact on the 
private sector: Peter Richmond.
    Estimate approved by: Peter H. Fontaine, Deputy Assistant 
Director for Budget Analysis.

            VI. Application of Law to the Legislative Branch

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

                    VII. 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.

                   VIII. Section-by-Section Analysis


Section 1. Short title

    ``Trauma Care Systems Planning and Development Act of 
2005''.

Section 2. 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 and 
standardized manner. This Section also eliminates authorization 
for the Clearinghouse on Trauma Care and Emergency Medical 
Services (EMS).
    This section 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. It also 
requests the Secretary to update the model trauma care plan.
    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 the 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; fifth fiscal year--$2 
State: $1 Federal; and subsequent fiscal years--$2 State: $1 
Federal.
    This section authorizes the appropriation of $12,000,000 
for fiscal year 2006 and such sums as may be necessary for 
fiscal years 2007 through 2010.
    This section requests an Institute of Medicine study on the 
state of trauma care and trauma research and authorizes 
$750,000 for fiscal year 2008 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 2005

           *       *       *       *       *       *       *



                         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) * * *
          (2) * * *
          (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;
          [(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 be 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.--* * *
          (1) * * *
          (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--* * *

           *       *       *       *       *       *       *

          (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.--* * *
                  (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) * * *
          (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 or 
        requirements for--

           *       *       *       *       *       *       *

          (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 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) * * *
          (10) coordinates planning for trauma systems with 
        State disaster emergency planning and bioterrorism 
        hospital pregardeness planniong;
          [10] (11) * * *
          [11] (12) * * *
    (b) Certain Standards With Respect to Trauma Care Centers 
and Systems.--
          (1) In general.--* * *
                  (A) take into account national standards 
                [concerning such] that outline resources for 
                optimal care of the injured patient;

           *       *       *       *       *       *       *

                  (D) beginning in fiscal year [1992] 2005, 
                take into account the model plan described in 
                subsection (c).

           *       *       *       *       *       *       *

          (3) Approval by secretary.--* * *
                  (A) in the case of payments for fiscal year 
                [1991] 2005 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] 2005 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] 2005, 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] 2005 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] 2005, 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.--* * *
          (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] 2007, 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 2005, and such sums as 
may be necessary for each of the fiscal years 2006 through 
2009.
    (b) Allocation of Funds by Secretary.--
          (1) * * *
          (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] 2005 through 2009.

           *       *       *       *       *       *       *


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

           *       *       *       *       *       *       *


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 2005 and 2006.

           *       *       *       *       *       *       *


            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) * * *
                  (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) * * *

           *       *       *       *       *       *       *

    [(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] 2005 through 2009.

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