[Senate Report 109-362]
[From the U.S. Government Publishing Office]





                                                       Calendar No. 667
109th Congress                                                   Report
                                 SENATE
 2d Session                                                     109-362

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



 
 KEEPING SENIORS SAFE FROM FALLS AND REAUTHORIZATION OF THE TRAUMATIC 
                            BRAIN INJURY ACT

                                _______
                                

                December 5, 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. 1531]

    The Committee on Health, Education, Labor, and Pensions, to 
which was referred the bill (S. 1351) to direct the Secretary 
of Health and Human Services to expand and intensify programs 
with respect to research and related activities concerning 
elder falls, having considered the same, reports favorably 
thereon with an amendment, and an amendment to the title, and 
recommends that the bill (as amended) do pass.

                                CONTENTS

                                                                   Page
  I. Purpose and Need for Legislation.................................1
 II. Summary..........................................................3
III. History of Legislation and Votes in Committee....................3
 IV. Explanation of Bill and Committee Views..........................4
  V. Cost Estimate....................................................5
 VI. Regulatory Impact Statement......................................7
VII. Application of Law to the Legislative Branch.....................7
VIII.Section-by-Section Analysis......................................7

 IX. Changes in Existing Law.........................................10

                  I. Purpose and Need for Legislation

    The purpose of ``Keeping Elders Safe from Falls and 
Reauthorization of the Traumatic Brain Injury Act'' is to 
direct the Secretary of Health and Human Services (HHS) to 
expand and intensify programs with respect to research and 
related activities concerning traumatic brain injury (TBI) and 
elder falls. In older Americans, falling is the leading cause 
of injury and death, and the main cause of TBI. Every year, of 
the 1.4 million people in the United States who sustain a TBI, 
50,000 die and 235,000 are hospitalized. According to the 
Centers for Disease Control and Prevention (CDC), falls among 
older adults and traumatic brain injuries cost the United 
States an estimated 80 billion dollars in 2000.
    TBI is defined as brain damage from some externally 
inflicted trauma to the head that results in significant 
impairment to an individual's physical, psychosocial, and/or 
cognitive functional abilities. According to CDC, brain 
injuries are among the most likely types of injury to cause 
death or permanent disability. People ages 15 to 24 years and 
those over age 75 are the two age groups at highest risk for 
TBI. Motor vehicle accidents, sports accidents, falls, and 
violence are the major causes of TBI. Whereas motor vehicle 
accidents and violence, such as firearm assaults and child 
abuse, account for 70% of TBI in the overall US population, 
falling is the major cause in people aged 75 years or older. 
TBI is also caused by explosives, and medical experts have 
described it as the signature wound of the Iraq war. Long known 
as the silent epidemic, TBI can strike anyone--infant, youth, 
or elderly person--without warning and with devastating 
results. It is particularly common among young males and people 
of both sexes who are 75 years and older. TBI affects the whole 
family and often results in huge medical and rehabilitation 
expenses over a lifetime.
    TBI is different from other disabilities due to the 
severity of cognitive loss. Most rehabilitation programs are 
designed for people with physical disabilities, not cognitive 
disabilities that require special accommodations. Finding 
needed services is typically a logistical, financial, and 
psychological challenge for family members and other 
caregivers, because few coordinated systems of care exist for 
individuals with TBI. The passage of the Traumatic Brain Injury 
Act of 1996 has improved TBI service systems at the state-level 
and also increased the overall visibility of TBI. However, more 
work needs to be done at both the national and State level to 
build an effective, durable service system for meeting the 
needs of individuals with TBI and their families.
    More than one-third of adults aged 65 and older fall each 
year. According to the CDC, in 2002, more than 12,800 people 
aged 65 and older died from fall-related injuries. More than 
1.6 million seniors were treated that year in emergency 
departments for fall-related injuries. Hospital admissions for 
hip fractures among the elderly have increased from 321,000 
admissions in 1988 to 327,000 in 2001. Annually, more than 
80,000 individuals who are over 65 years of age sustain a TBI 
as a result of a fall.
    In addition to their effect on the quality of life of 
seniors and their families, falls also have an impact on 
healthcare costs due to increased physician visits, emergency 
room use and hospitalization. According to the CDC, the direct 
medical cost totaled 179 million dollars for fatal and 19 
billion dollars for nonfatal fall injuries in 2000.
    To address the impact of falls on seniors, their families, 
and healthcare costs, the Keeping Elders Safe from Falls and 
Reauthorization of the Traumatic Brain Injury Act of 2006 would 
focus ongoing Federal efforts to prevent falls among older 
adults on three priorities: (1) developing a national education 
campaign to reduce falls among older adults; (2) intensifying 
services and conducting research to determine the most 
effective approaches to preventing and treating falls among 
older adults; and (3) directing the Secretary of Health and 
Human Services (HHS) to evaluate the effect of falls on health 
care costs, the potential for reducing falls, and the most 
effective strategies for reducing health care costs associated 
with falls.

                              II. Summary

    The purpose of this legislation is to expand and improve 
programs that authorize activities related to TBI and to reduce 
falls among the elderly. With respect to TBI, the legislation 
authorizes three federal agencies to carry out activities 
addressing TBI:
          (1) The Centers for Disease Control and Prevention 
        (CDC) carries out projects that reduce the incidence of 
        TBI through research, public education, and a national 
        education and awareness campaign, gives grants to 
        States to operate TBI registries, and funds academic 
        research supporting the development of registries.
          (2) Supports basic and applied research conducted by 
        the National Institutes of Health (NIH).
          (3) Health Resources Service Administration (HRSA) 
        awards grants to fund State demonstration projects to 
        improve access to health and other services and for 
        protection and advocacy service systems.
    With respect to the issue of senior falls the legislation 
directs the Department of Health and Human Services (HHS) to:
          (1) Develop public education programs on fall 
        prevention for the elderly, family members, caregivers, 
        and others involved with the elderly.
          (2) Intensify services and conduct research to 
        determine the most effective approaches to preventing 
        and treating falls among older adults; and
          (3) Evaluate the effect of falls on health care 
        costs, the potential for reducing falls, and the most 
        effective strategies for reducing health care costs 
        associated with falls.

           III. History of Legislation and Votes in Committee

    S. 1531, Keeping Seniors Safe from Falls Act and 
Reauthorization of the Traumatic Brain Injury Act is a 
combination of two bills--The Keeping Seniors Safe from Falls 
Act and the Traumatic Brain Injury Reauthorization. On 
September 20, 2006, the committee considered and unanimously 
approved a manager's amendment to S. 1531. Senators MIKULSKI, 
HATCH, KENNEDY, DEWINE, MURRAY, and ISAKSON cosponsored the 
manager's amendment.
    During the 109th Congress, S. 1531, The Keeping Seniors 
Safe from Falls Act was introduced by Senator ENZI for himself 
and Senator MIKULSKI on July 28, 2005. Senators BAUCUS, DOLE, 
GRASSLEY, COCHRAN, DURBIN, ISAKSON and MURRAY cosponsored the 
bill.
    The legislation was first introduced during the 107th 
Congress, on February 7, 2002, by Senator HUTCHINSON, for 
himself and Senators MIKULSKI and ENZI, as S. 1922.
    Senators BAUCUS, MILLER and MURRAY also cosponsored S. 
1922. The Health, Education, Labor, and Pensions (HELP) 
Subcommittee on Aging held a hearing on S. 1922 on June 11, 
2002.
    The bill was reintroduced as S. 1217 during the 108th 
Congress on June 9, 2003, by Senator ENZI, for himself and 
Senator MIKULSKI. Senators MURRAY, BAUCUS, GRASSLEY, COCHRAN, 
LAUTENBERG, BINGAMAN, and BUNNING also cosponsored S. 1217. On 
September 22, 2004, the HELP Committee considered a substitute 
amendment to S. 1217 offered by Senators ENZI and MIKULSKI, 
which was approved by unanimous consent.
    The Traumatic Brain Injury Act Reauthorization of 2006 was 
introduced by Senator HATCH for himself and Senator KENNEDY on 
July 16, 2006.
    The original Traumatic Brain Injury Act, introduced by 
Senator HATCH for himself and Senator KENNEDY, was signed into 
law (P.L. 104-166) on July 29, 1996. On September 20, 2000, 
Senator HATCH introduced the Traumatic Brain Injury Act 
Amendments of 2000 to reauthorize the program. The bill was 
included as part of the Children's Health Act (P.L. 106-310), 
which was signed into law on October 17, 2000.

              IV. Explanation of Bill and Committee Views

    The Keeping Seniors Safe from Falls Act and Reauthorization 
of the Traumatic Brain Injury Act directs the Secretary of HHS 
to intensify and expand the Department's efforts to prevent and 
treat injuries. The legislation focuses on traumatic brain 
injury and reducing and preventing falls among older adults. 
The committee authorizes from 2007 through 2010 such sums as 
may be necessary for TBI programs and elder falls programs 
administered by the Centers for Disease Control and Prevention 
(CDC), the Health Resources Service Administration (HRSA) and 
the National Institutes of Health (NIH).
    Minor changes are made to TBI activities administered by 
CDC and NIH to improve prevention and research activities. A 
collaborative study between CDC and NIH is authorized to 
determine the incidence and prevalence of TBI; collect, 
maintain and report national trends; identify common 
therapeutic interventions; and develop practice guidelines. The 
committee also sees it necessary for other Federal agencies 
such as the Department of Defense (DOD), which conducts TBI 
research, to be consulted for the report. This will more 
effectively coordinate and maximize efforts at the Federal 
level to better understand TBI.
    The HRSA grant program was amended to improve access to 
rehabilitation and other services related to TBI. Recognizing 
that TBI is a leading cause of death and disability among 
American Indians/Alaska Indians, tribal communities are 
eligible to apply for grants. The efficiency of protection and 
advocacy grants is strengthened by directing HRSA and 
Administration on Developmental Disabilities (ADD) to 
coordinate data collection related to services. Payments for 
grants shall be distributed no later than October 1 of each 
fiscal year.
    The legislation directs the Secretary of HHS to refocus the 
Department's efforts to prevent falls among older adults 
through public education and research, and to assess the impact 
that falls have on healthcare costs. The committee expects the 
Secretary to carry out his authority through agencies, such as 
the CDC and its National Center for Injury Prevention and 
Control (NCIPC), which have the necessary experience and 
expertise to conduct and support such work.
    The committee expects the public education campaign to be 
directed principally to older adults, their families, and 
healthcare providers, and to be focused on the twin goals of 
reducing falls among older adults and preventing repeat falls. 
HHS or its designated agency should consider organizations with 
expertise in designing and implementing large-scale programs to 
prevent injuries; experience in working in cooperation with 
government agencies, businesses and corporate organizations; 
and other non-profit organizations and institutions and the 
capability to carry out major public education campaigns on a 
national basis.
    The committee believes that HHS should utilize the injury 
prevention and community health education expertise available 
at colleges and universities in carrying out provisions of this 
act. The committee urges HHS to involve these and other 
qualified organizations and institutions in the implementation 
of this legislation.
    The committee sees it necessary to raise the authorization 
of appropriations level for Part J--PREVENTION AND CONTROL OF 
ACTIVITIES, which is the authorization of appropriations line 
for injury prevention activities, including TBI and Elder Falls 
Activities, to be increased from $50 million to $58,361,000 for 
fiscal year 2007 and such sums from 2008-2010. The increase is 
to meet the level appropriated by appropriators in fiscal year 
2007, not to authorize new money.

                            V. Cost Estimate


S. 1531--Keeping Seniors Safe From Falls and Reauthorization of the 
        Traumatic Brain Injury Act

    Summary: S. 1531 would authorize appropriations for 
activities related to injuries and traumatic brain injury (TBI) 
conducted by the National Institutes of Health (NIH), the 
Centers for Disease Control and Prevention (CDC), and the 
Health Resources and Services Administration (HRSA). It also 
would authorize and expand certain ongoing activities at CDC 
related to injuries due to falls experienced by older 
Americans, and would allow consortia of American Indians to 
receive HRSA grants for improving access to TBI services.
    Assuming the appropriation of the authorized amounts, CBO 
estimates that implementing S. 1531 would cost $126 million in 
2007 and $1.6 billion over the 1007-2011 period. Enacting S. 
1531 would not affect direct spending or revenues.
    S. 1531 contains no intergovernmental or private-sector 
mandates as defined in the Unfunded Mandates Reform Act (UMRA).
    Estimated cost to the Federal Government: The estimated 
budgetary impact is shown in the following table. The costs of 
this legislation fall within budget function 550 (health).
    Basis of estimate: For this estimate, CBO assumes that S. 
1531 will be enacted near the start of fiscal year 2007, that 
the necessary amounts will be appropriated for each fiscal 
year, and that outlays will follow the historical spending 
rates of similar NIH, CDC, and HRSA programs.

----------------------------------------------------------------------------------------------------------------
                                                               By fiscal year, in millions of dollars--
                                                     -----------------------------------------------------------
                                                        2006      2007      2008      2009      2010      2011
----------------------------------------------------------------------------------------------------------------
                                        SPENDING SUBJECT TO APPROPRIATION

Spending Under Current Law:
    Budget Authority\1\.............................       391         0         0         0         0         0
    Estimated Outlays...............................       391       260        44        15         1         0
Proposed Changes:
    Estimated Authorization Level...................         0       399       411       417       426         0
    Estimated Outlays...............................         0       126       349       388       410       281
Spending Under S. 1531:
    Estimated Authorization Level\1\................       391       399       411       417       426         0
    Estimated Outlays...............................       391       386       393       403       411       281
----------------------------------------------------------------------------------------------------------------
\1\The 2006 level is the amount appropriated that year for trauma- and injury-related activities at NIH, CDC,
  and HRSA.

    S. 1531 would modify the Public Health Service Act to 
authorize funding through fiscal year 2010 for NIH and HRSA 
activities related to trauma and for CEC activities related to 
injuries and TBI. The bill would expand the scope of HRSA's 
program of grants to improve access to TBI treatment by 
allowing consortia of American Indians to receive grants that 
currently are restricted to states. The bill would also require 
the CDC and NIH to conduct a study on the prevalence of TBI and 
the efficacy of medical interventions against it. CBO estimates 
that the NIH, CDC, and HRSA would require budget authority of 
$399 million for 2007 and $1.7 billion for the 2007-2011 period 
to carry out the activities specified in S. 1531. That total is 
equivalent to the 2006 appropriation level with an adjustment 
for anticipated inflation. Assuming appropriation of the 
necessary amounts, CBO estimates that implementing S. 1531 
would cost $126 million in 2007 and $1.6 billion over the 2007-
2011 period.
    The NIH estimates that it will allocate $325 million to 
trauma-related activities in 2006. S. 1531 would authorize the 
appropriation of such sums as are necessary for such activities 
over the 2007-2010 period. Based on historical program 
expenditures at NIH and adjusting for inflation, CBO estimates 
that it would require budget authority of $333 million for 2007 
and $1.4 billion over the 2007-2011 period to conduct the 
authorized activities.
    Implementing S. 1531 at the NIH would cost $99 million in 
2007 and $1.3 billion over the 2007-2011 period, CBO estimates, 
assuming appropriation of the necessary amounts and that 
spending for the programs would follow historical patterns for 
similar activities.
    Based on information from the CDC, CBO estimates that for 
2006 the CDC allocated about $58 million to research, 
education, and prevention activities described by S. 1531, 
including activities related to TBI and falls among the 
elderly. S. 1531 would authorize the appropriation for those 
activities of $58 million for 2007, and such sums as are 
necessary for those activities for fiscal years 2008 through 
2010. The bill also would direct CDC to engage in new research, 
education campaigns, and demonstration programs related to the 
effects and prevention of injuries due to falls among seniors. 
CBO estimates that CDC would require $250 million in budget 
authority over the 2007-2011 periods, including the $58 million 
that would be authorized for 2007, to implement those 
previsions. Based on historical spending patterns for similar 
activities, and assuming appropriation of authorized and 
necessary amounts, CBO estimates that implementing continued 
CDC activities would cost $23 million in 2007 and $236 million 
over the 2007-2011 period.
    HRSA allocated $8 million in 2006 for grants to states to 
expand access to care for TBI. S. 1531 would authorize the 
appropriation of such sums as are necessary for those 
activities over the 2007-2010 period, and would expand the 
program to allow consortia of American Indians to receive such 
grants. Based on historical spending of the programs, VBO 
estimates that the agency would require budget authority of $8 
million in 2007 and $36 million over the 2007-2011 period to 
carry out activities specified during the period specified by 
the bill. CBO estimates that implementing those provisions of 
S. 1531 would cost $4 million in 2007 and $36 million over the 
2007-2011 period, assuming appropriation of necessary amounts 
and that future rates of spending follow historical patterns 
for similar activities.
    Intergovernmental and Private-Sector Impact: S. 1531 
contains no intergovernmental or private-sector mandates as 
defined in UMRA. State governments and Indian consortia would 
benefit from grant funding authorized by the bill. Any costs 
incurred by those entities to qualify for such grants would be 
incurred voluntarily as conditions of federal assistance.
    Estimate prepared by: Federal Costs: Tim Gronniger, Camile 
Williams. Impact on State, Local, and Tribal Governments: Leo 
Lex. Impact on the Private Sector: Paige Shevlin.
    Estimate approved by: Peter H. Fontaine, Deputy Assistant 
Director for Budget Analysis.

                    VI. Regulatory Impact Statement

    Pursuant to the requirements of paragraph 11(b) of rule 
XXVI of the Standing Rules of the Senate, the committee has 
determined that the bill will not have a significant regulatory 
impact.

           VII. Application of Law to the Legislative Branch

    The Committee has determined there is no impact of this law 
on the legislative branch.

                   VIII. Section-by-Section Analysis


Section 1. Short title

    Section 1 provides the short title of the bill, the Keeping 
Seniors Safe from Falls and Reauthorization of the Traumatic 
Brain Injury Act.

Section 2. Conforming amendments relating to restructuring

    Section 2 redesignates (1) Section 393B as section 393A, 
(2) Section 393A as section 393B; and (3) section 393B as 
section 393C.

Section 3. Traumatic Brain Injury Programs of the Centers for Disease 
        and Prevention

    Section 3 amends Part J of Title III of the Public Health 
Service Act as redesignated (42 U.S.C. 280b-1b) to authorize 
the dissemination of information related to TBI and the 
sequelae of secondary conditions arising from TBI upon an 
individual's discharge from hospitals and emergency centers.
    Section 393C of the Public Health Service Act, as 
redesignated (42 U.S.C. 280B et seq.) is amended to change the 
heading of the section to ``National Program for Traumatic 
Brain Injury Surveillance and Registry.'' This section 
authorizes grants to States or their designees to develop or 
operate the State's TBI surveillance system or registry to 
determine the incidence and prevalence of TBI. The Secretary is 
authorized to ensure the uniformity of reporting information. 
Also directs individuals with TBI to be linked with academic 
institutions to conduct applied research that will support the 
development of such surveillance systems and registries as 
necessary.

Sec. 4. Study of traumatic brain injury

    This section authorizes the CDC to conduct a study in 
coordination with the NIH to study activities related to TBI. 
Activities include determining the incidence and prevalence of 
TBI in all age groups; collecting, maintaining and reporting 
national trends; identifying interventions used for 
rehabilitation and their effectiveness; analyzing the adequacy 
of existing measures of outcomes and knowledge of factors 
influencing differential outcomes; and developing guidelines 
for patient rehabilitation after TBI.
    The report shall be submitted to Congress no later than 3 
years after the date of enactment.

Sec. 5. Traumatic Brain Injury Programs of the National Institutes of 
        Health

    This section reauthorizes the current grant program to 
conduct basic and clinical research on trauma, including 
diagnosis treatment rehabilitation, and general management of 
trauma and TBI.
    This section authorizes such sums as may be necessary for 
each fiscal years 2007-2010.

Sec. 6. Traumatic Brain Injury Programs of all Health Resources and 
        Service Administration

    This section reauthorizes the Secretary to award grants to 
States, and authorizes the Secretary to award grants to 
American Indian Consortia, for the purpose of carrying out 
projects to improve access to health and other services 
regarding TBI.
    This section authorizes the Secretary to submit to the 
committees of jurisdiction no less than bi-annually, a report 
describing the findings, and results of the programs 
established under this section, including measures outcomes and 
consumer and surrogate satisfaction. The surrogate refers to 
the individual who has the authority to make decisions on 
behalf of the individual receiving TBI services.
    Definitions in this section include American Indian 
consortium and TBI.
    Grants are authorized for such sums as may be necessary for 
each of the fiscal years 2007 through 2010.
    This section authorizes the Secretary to award grants to 
protection and advocacy systems for the purpose of enabling 
such systems to provide services to individuals with TBI.
    This section directs the Administration to pay directly to 
any protection and advocacy system that complies with the 
provisions of this section, no later than October 1.
    This section requires the Administrator of Health Resources 
Service Administration and the Commissioner of the 
Administration of Developmental Disabilities to enter into an 
agreement to coordinate the collection of data by the 
Administrator and the Commissioner regarding protection and 
advocacy services.
    This section requires for any fiscal year for which the 
amount appropriated is $6 million or greater, the Administrator 
to use 2 percent of such amount to make a grant to an eligible 
national association for providing training and technical 
assistance for protection and advocacy systems.
    In this section, eligible national association means a 
national association with demonstrated experience in providing 
training and technical assistance to protection and advocacy 
systems.
    This section gives a protection and advocacy system the 
same authorities as such a system would for the purpose of 
providing services under subtitle C of the Developmental 
Disabilities Assistance and Bill of Rights Act of 2000.

Sec. 7. Amendments to the Public Health Service Act Relating to Elder 
        Falls

    Section 7 amends Part J of Title III of the Public Health 
Service Act to add a new section 393D, Prevention of Falls 
Among Older Adults.
    Subsection (a) directs HHS to establish a national public 
education campaign to prevent falls among older adults and 
prevent repeat falls. It also establishes authority for HHS to 
make grants or enter into contracts or cooperative agreements 
to assist state-level coalitions in conducting local education 
campaigns to reduce falls among older adults.
    Subsection (b) directs HHS to conduct and support research 
in areas such as identifying older adults who have a high risk 
of falling; designing, implementing, and evaluating the most 
effective ways to prevent falls; improving diagnosis, 
treatment, and rehabilitation of older adults who have fallen; 
tailoring proven fall reduction strategies to specific 
populations of older adults; and eliminating barriers to 
adopting proven fall prevention methods. It also directs the 
HHS Secretary to make grants or enter into contracts or 
cooperative agreements to provide professional education for 
physicians, allied health professionals and aging service 
providers in fall prevention, evaluation and management.
    Subsection (c) gives HHS the authority to conduct and 
support demonstration programs to assess the utility of 
targeted fall risk screening and referral programs; programs 
that use multiple approaches to prevent falls; and programs 
targeting newly discharged fall victims at high risk for second 
falls. HHS may also conduct and support demonstration programs 
to develop technology to prevent falls among older adults and 
prevent or reduce fall-related injuries, and to implement and 
evaluate fall prevention programs using proven intervention 
strategies in different settings.
    Subsection (d) directs the Secretary to evaluate the effect 
of falls on health care costs, the potential for reducing 
falls, and the most effective strategies for reducing fall-
related health care costs.

Sec. 8. Authorization of Appropriations

    This section authorizes the appropriation of $58,361,000 
for fiscal year 2007 and such sums as may be necessary for 
fiscal years 2007 through 2010.

                      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

           *       *       *       *       *       *       *



     TITLE III--GENERAL POWERS AND DUTIES OF PUBLIC HEALTH SERVICE


Part A--Research and Investigation

           *       *       *       *       *       *       *



               Part J--Prevention and Control of Injuries


                                RESEARCH

    Sec. 391. (a) * * *

           *       *       *       *       *       *       *


     INTERPERSONAL VIOLENCE WITHIN FAMILIES AND AMONG ACQUAINTANCES

    Sec. 393. (a) * * *

           *       *       *       *       *       *       *


SEC. [393B] 393A. USE OF ALLOTMENTS FOR RAPE PREVENTION EDUCATION.

    (a) Permitted Use.--* * *

           *       *       *       *       *       *       *


                  PREVENTION OF TRAUMATIC BRAIN INJURY

    Sec. [393A] 393B. (a) In General.--* * *
    (b) * * *
          (1) * * *

           *       *       *       *       *       *       *

          (3) the implementation of a national education and 
        awareness campaign regarding such injury (in 
        conjunction with the program of the Secretary regarding 
        health-status goals for 2010, commonly referred to as 
        Healthy People 2010), including--
                  (A) the national dissemination of information 
                on--
                          (i) incidence and prevalence; and
                          (ii) information relating to 
                        traumatic brain injury and the sequelae 
                        of secondary conditions arising from 
                        traumatic brain injury upon discharge 
                        [from hospitals and trauma centers] 
                        from hospitals and emergency 
                        departments; and

           *       *       *       *       *       *       *


NATIONAL PROGRAM FOR TRAUMATIC BRAIN INJURY SURVEILLANCE AND REGISTRIES

    Sec. [393B] 393C. [(a) In General.--]The Secretary, acting 
through the Director of the Centers for Disease Control and 
Prevention, [may make grants to States or their designees to 
operate the State's traumatic brain injury registry, and to 
academic institutions to conduct applied research that will 
support the development of such registries, to collect data 
concerning--] may make grants to States or their designees to 
develop or operate the State's traumatic brain injury 
surveillance system or registry to determine the incidence and 
prevalence of traumatic brain injury and related disability, to 
ensure the uniformity of reporting under such system or 
registry, to link individuals with traumatic brain injury to 
services and supports, and to link such individuals with 
academic institutions to conduct applied research that will 
support the development of such surveillance systems and 
registries as may be necessary. A surveillance system or 
registry under this section shall provide for the collection of 
data concerning--

           *       *       *       *       *       *       *


SEC. 393C-1. STUDY ON TRAUMATIC BRAIN INJURY.

    (a) Study.--The Secretary, acting through the Director of 
the Centers for Disease Control and Prevention with respect to 
paragraph (1) and the Director of the National Institutes of 
Health with respect to paragraphs (2) and (3), shall conduct a 
study with respect to traumatic brain injury for the purpose of 
carrying out the following:
          (1) In collaboration with appropriate State and local 
        health-related agencies--
                  (A) determining the incidence of traumatic 
                brain injury and prevalence of traumatic brain 
                injury related disability in all age groups in 
                the general population of the United States, 
                including institutional settings, such as 
                nursing homes, correctional facilities, 
                psychiatric hospitals, child care facilities, 
                and residential institutes for people with 
                developmental disabilities; and
                  (B) reporting national trends in traumatic 
                brain injury.
          (2) Identifying common therapeutic interventions 
        which are used for the rehabilitation of individuals 
        with such injuries, and, subject to the availability of 
        information, including an analysis of--
                  (A) the effectiveness of each such 
                intervention in improving the functioning, 
                including return to work or school and 
                community participation, of individuals with 
                brain injuries;
                  (B) the comparative effectiveness of 
                interventions employed in the course of 
                rehabilitation of individuals with brain 
                injuries to achieve the same or similar 
                clinical outcome; and
                  (C) the adequacy of existing measures of 
                outcomes and knowledge of factors influencing 
                differential outcomes.
          (3) Developing practice guidelines for the 
        rehabilitation of traumatic brain injury at such time 
        as appropriate scientific research becomes available.
    (b) Dates Certain for Reports.--Not later than 3 years 
after the date of the enactment of the Keeping Seniors Safe 
from Falls and Reauthorization of the Traumatic Brain Injury 
Act, the Secretary shall submit to the Congress a report 
describing findings made as a result of carrying out subsection 
(a).
    (c) Definition.--For purposes of this section, 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.

SEC. 393D. PREVENTION OF FALLS AMONG OLDER ADULTS.

    (a) Public Education.--The Secretary shall--
          (1) oversee and support a national education campaign 
        to be carried out by a nonprofit organization with 
        experience in designing and implementing national 
        injury prevention programs, that is directed 
        principally to older adults, their families, and health 
        care providers, and that focuses on reducing falls 
        among older adults and preventing repeat falls; and
          (2) award grants, contracts, or cooperative 
        agreements to qualified organizations, institutions, or 
        consortia of qualified organizations and institutions, 
        for the purpose of organizing State-level coalitions of 
        appropriate State and local agencies, safety, health, 
        senior citizen, and other organizations to design and 
        carry out local education campaigns, focusing on 
        reducing falls among older adults and preventing repeat 
        falls.
    (b) Research.--
          (1) In general.--The Secretary shall--
                  (A) conduct and support research to--
                          (i) improve the identification of 
                        older adults who have a high risk of 
                        falling;
                          (ii) improve data collection and 
                        analysis to identify fall risk and 
                        protective factors;
                          (iii) design, implement, and evaluate 
                        the most effective fall prevention 
                        interventions;
                          (iv) improve strategies that are 
                        proven to be effective in reducing 
                        falls by tailoring these strategies to 
                        specific populations of older adults;
                          (v) conduct research in order to 
                        maximize the dissemination of proven, 
                        effective fall prevention 
                        interventions;
                          (vi) intensify proven interventions 
                        to prevent falls among older adults;
                          (vii) improve the diagnosis, 
                        treatment, and rehabilitation of 
                        elderly fall victims and older adults 
                        at high risk for falls; and
                          (viii) assess the risk of falls 
                        occurring in various settings;
                  (B) conduct research concerning barriers to 
                the adoption of proven interventions with 
                respect to the prevention of falls among older 
                adults;
                  (C) conduct research to develop, implement, 
                and evaluate the most effective approaches to 
                reducing falls among high-risk older adults 
                living in communities and long-term care and 
                assisted living facilities; and
                  (D) evaluate the effectiveness of community 
                programs designed to prevent falls among older 
                adults.
          (2) Educational support.--The Secretary, either 
        directly or through awarding grants, contracts, or 
        cooperative agreements to qualified organizations, 
        institutions, or consortia of qualified organizations 
        and institutions, shall provide professional education 
        for physicians and allied health professionals, and 
        aging service providers in fall prevention, evaluation, 
        and management.
    (c) Demonstration Projects.--The Secretary shall carry out 
the following:
          (1) Oversee and support demonstration and research 
        projects to be carried out by qualified organizations, 
        institutions, or consortia of qualified organizations 
        and institutions, in the following areas:
                  (A) A multistate demonstration project 
                assessing the utility of targeted fall risk 
                screening and referral programs.
                  (B) Programs designed for community-dwelling 
                older adults that utilize multicomponent fall 
                intervention approaches, including physical 
                activity, medication assessment and reduction 
                when possible, vision enhancement, and home 
                modification strategies.
                  (C) Programs that are targeted to new fall 
                victims who are at a high risk for second falls 
                and which are designed to maximize independence 
                and quality of life for older adults, 
                particularly those older adults with functional 
                limitations.
                  (D) Private sector and public-private 
                partnerships to develop technologies to prevent 
                falls among older adults and prevent or reduce 
                injuries if falls occur.
          (2)(A) Award grants, contracts, or cooperative 
        agreements to qualified organizations, institutions, or 
        consortia of qualified organizations and institutions, 
        to design, implement, and evaluate fall prevention 
        programs using proven intervention strategies in 
        residential and institutional settings.
          (B) Award 1 or more grants, contracts, or cooperative 
        agreements to 1 or more qualified organizations, 
        institutions, or consortia of qualified organizations 
        and institutions, in order to carry out a multistate 
        demonstration project to implement and evaluate fall 
        prevention programs using proven intervention 
        strategies designed for single and multifamily 
        residential settings with high concentrations of older 
        adults, including--
                  (i) identifying high-risk populations;
                  (ii) evaluating residential facilities;
                  (iii) conducting screening to identify high-
                risk individuals;
                  (iv) providing fall assessment and risk 
                reduction interventions and counseling;
                  (v) coordinating services with health care 
                and social service providers; and
                  (vi) coordinating post-fall treatment and 
                rehabilitation.
          (3) Award 1 or more grants, contracts, or cooperative 
        agreements to qualified organizations, institutions, or 
        consortia of qualified organizations and institutions, 
        to conduct evaluations of the effectiveness of the 
        demonstration projects described in this subsection.
    (d) Study of Effects of Falls on Health Care Costs.--
          (1) In general.--The Secretary shall conduct a review 
        of the effects of falls on health care costs, the 
        potential for reducing falls, and the most effective 
        strategies for reducing health care costs associated 
        with falls.
          (2) Report.--Not later than 36 months after the date 
        of enactment of the Keeping Seniors Safe from Falls and 
        Reauthorization of the Traumatic Brain Injury Act, the 
        Secretary shall submit to Congress a report describing 
        the findings of the Secretary in conducting the review 
        under paragraph (1).

           *       *       *       *       *       *       *


                    AUTHORIZATIONS OF APPROPRIATIONS

    Sec. 394A. For the purpose of carrying out this part, there 
are authorized to be appropriated [$50,000,000 for fiscal year 
1994, and\1\ such sums as may be necessary for each of the 
fiscal years 1995 through 1998, and such sums as may be 
necessary for each of the fiscal years 2001 through 2005.] 
$58,361,000 for fiscal year 2007, and such sums as may be 
necessary for each of fiscal years 2008 through 2010.

           *       *       *       *       *       *       *


SEC. 1252. STATE GRANTS FOR DEMONSTRATION\1\ PROJECTS REGARDING 
                    TRAUMATIC BRAIN INJURY.

    (a) In General.--The Secretary, acting through the 
Administrator of the Health Resources and Services 
Administration, [may make grants to States] may make grants to 
States and American Indian consortia for the purpose of 
carrying out projects to improve access to [health and other 
services] rehabilitation and other services regarding traumatic 
brain injury.
    (b) State Advisory Board.--
          (1) In general.--The Secretary may make a grant under 
        subsection (a) only if the [State] State or American 
        Indian consortium involved agrees to establish an 
        advisory board within the appropriate health department 
        of the [State] State or American Indian consortium or 
        within another department as designated by the chief 
        executive officer of the [State] State or American 
        Indian consortium.
          (2) Functions.--An advisory board established under 
        paragraph (1) shall advise and make [recommendations to 
        the State] recommendations to the State or American 
        Indian consortium on ways to improve services 
        coordination regarding traumatic brain injury. Such 
        advisory boards shall encourage citizen participation 
        through the establishment of public hearings and other 
        types of community outreach programs. In developing 
        recommendations under this paragraph, such boards shall 
        consult with Federal, State, and local governmental 
        agencies and with citizens groups and other private 
        entities.
          (3) Composition.--An advisory board established under 
        paragraph (1) shall be composed of--
                  (A) representatives of--
                          (i) the corresponding [State] State 
                        or American Indian consortium agencies 
                        involved;
                          (ii) public and nonprofit private 
                        health related organizations;
                          (iii) other disability advisory or 
                        planning groups within the [State] 
                        State or American Indian consortium;
                          (iv) members of an organization or 
                        foundation representing individuals 
                        with traumatic brain injury in that 
                        [State] State or American Indian 
                        consortium; and

           *       *       *       *       *       *       *

    (c) Matching Funds.--
          (1) In general.--with respect to costs to be incurred 
        by a [State] State or American Indian consortium in 
        carrying out the purpose described in subsection (a), 
        the Secretary may make a grant under such subsection 
        only if the [State] State or American Indian consortium 
        agrees to make available non-Federal contributions 
        toward such costs in an amount that is not less than $1 
        for each $2 of Federal funds provided under the grant.
          (2) Determination of amount contributed.--* * *

           *       *       *       *       *       *       *

    (e) Continuation of Previously Awarded Demonstration 
Projects.--[A State that received a grant under this section 
prior to the date of the enactment of the Children's Health Act 
of 2000 may compete for new project grants under this section 
after such date of the enactment.] State or American Indian 
consortium that received a grant under this section prior to 
the date of the enactment of the Keeping Seniors Safe from 
Falls and Reauthorization of the Traumatic Brain Injury Act may 
complete the activities funded by the grant.
    (f) Use of State and American Indian Consortium Grants.--
          (1) Community services and supports.--A [State] State 
        or American Indian consortium shall (directly or 
        through awards of contracts to nonprofit private 
        entities) use amounts received under a grant under this 
        section for the following:
                  (A) * * *
                          (i) * * *
                          (ii) shall be designed for [children 
                        and other individuals] children, youth, 
                        and adults with traumatic brain injury.

           *       *       *       *       *       *       *


           *       *       *       *       *       *       *

                  (E) To support other needs identified by the 
                advisory board under subsection (b) for the 
                [State] State or American Indian consortium 
                involved.
          (2) Best practices.--
                  (A) In general.--[State] State or American 
                Indian consortium services and supports 
                provided under a grant under this section shall 
                reflect the best practices in the field of 
                traumatic brain injury, shall be in compliance 
                with title II of the Americans with 
                Disabilities Act of 1990, and shall be 
                supported by quality assurance measures as well 
                as state-of-the-art health care and integrated 
                community supports, regardless of the severity 
                of injury.
                  (B) Demonstration by state agency.--The 
                [State] State or American Indian consortium 
                agency responsible for administering amounts 
                received under a grant under this section shall 
                demonstrate that it has obtained knowledge and 
                expertise of traumatic brain injury and the 
                unique needs associated with traumatic brain 
                injury.
          (3) State capacity building.--A [State] State or 
        American Indian consortium may use amounts received 
        under a grant under this section to * * *

           *       *       *       *       *       *       *

                  (E) tailor existing [State] State or American 
                Indian consortium systems to provide 
                accommodations to the needs of individuals with 
                brain injury (including systems administered by 
                the [State] State or American Indian consortium 
                departments responsible for health, mental 
                health, labor/employment, education, mental 
                retardation/developmental disorders, 
                transportation, and correctional systems);
                  (F) improve data sets coordinated across 
                systems and other needs identified by a [State] 
                State or American Indian consortium plan 
                supported by its advisory council; and

           *       *       *       *       *       *       *

    (h) Report.--[Not later than 2 years after the date of the 
enactment of this section, the Secretary] Not less than bi-
annually, the Secretary shall submit to the Committee on 
Commerce of the House of Representatives, and to the Committee 
on Labor and Human Resources of the Senate, a report describing 
the findings and results of the programs established under this 
section, section 1253, and section 1254, including measures of 
outcomes and consumer and surrogate satisfaction.
    [(i) Definition.--For purposes of this section, 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) Definitions.--For purposes of this section:
          (1) The terms ``American Indian consortium'' and 
        ``State'' have the meanings given to those terms in 
        section 1253.
          (2) 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 near 
        drowning. 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.
    (j) 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, and such sums as may be 
necessary for each of the fiscal years 2007 through 2010.

           *       *       *       *       *       *       *


SEC. 1253. STATE GRANTS FOR PROTECTION AND ADVOCACY SERVICES.

    (a) In General.--* * *

           *       *       *       *       *       *       *

    (d) Appropriations Less Than $2,700,000.--
          (1) In general.--With respect to any fiscal year in 
        which the amount appropriated under [subsection (i)] 
        subsection (l) to carry out this section is less than 
        $2,700,000, the Administrator shall make grants from 
        such amount to individual protection and advocacy 
        systems within States to enable such systems to plan 
        for, develop outreach strategies for, and carry out 
        services authorized under this section for individuals 
        with traumatic brain injury.
          (2) * * *
    (e) Appropriations of $2,700,000 or More.--
          (1) Population basis.--Except as provided in 
        paragraph (2), with respect to each fiscal year in 
        which the amount appropriated under [subsection (i)] 
        subsection (l) to carry out this section is $2,700,000 
        or more, the Administrator shall make a grant to a 
        protection and advocacy system within each State.
          (2) Amount.--The amount of a grant provided to a 
        system under paragraph (1) shall be equal to an amount 
        bearing the same ratio to the total amount appropriated 
        for the fiscal year involved under [subsection (i)] 
        subsection (l) as the population of the State in which 
        the grantee is located bears to the population of all 
        States.
          (3) * * *

           *       *       *       *       *       *       *

          (4) Inflation adjustment.--For each fiscal year in 
        which the total amount appropriated under [subsection 
        (i)] subsection (l) to carry out this section is 
        $5,000,000 or more, and such appropriated amount 
        exceeds the total amount appropriated to carry out this 
        section in the preceding fiscal year, the Administrator 
        shall increase each of the minimum grants amount 
        described in subparagraphs (A) and (B) of paragraph (3) 
        by a percentage equal to the percentage increase in the 
        total amount appropriated under [subsection (i)] 
        subsection (l) to carry out this section between the 
        preceding the fiscal year and the fiscal year involved.

           *       *       *       *       *       *       *

    (g) Direct Payment.--Notwithstanding any other provision of 
law, each fiscal year not later than October 1, the 
Administrator shall pay directly to any protection and advocacy 
system that complies with the provisions of this section the 
total amount of the grant for such system, unless the system 
provides otherwise for such payment.
    (h) * * *

           *       *       *       *       *       *       *

    (i) Data Collection.--The Administrator of the Health 
Resources and Services Administration and the Commissioner of 
the Administration on Developmental Disabilities shall enter 
into an agreement to coordinate the collection of data by the 
Administrator and the Commissioner regarding protection and 
advocacy services.
    (j) Training and Technical Assistance.--
          (1) Grants.--For any fiscal year for which the amount 
        appropriated to carry out this section is $6,000,000 or 
        greater, the Administrator shall use 2 percent of such 
        amount to make a grant to an eligible national 
        association for providing for training and technical 
        assistance to protection and advocacy systems.
          (2) Definition.--In this subsection, the term 
        ``eligible national association'' means a national 
        association with demonstrated experience in providing 
        training and technical assistance to protection and 
        advocacy systems.
    (k) System Authority.--In providing services under this 
section, a protection and advocacy system shall have the same 
authorities, including access to records, as such system would 
have for purpose of providing services under subtitle C of the 
Developmental Disabilities Assistance and Bill of Rights Act of 
2000.
    [(i)] (l) Authorization of Appropriations.--There are 
authorized to be appropriated to carry out this section 
$5,000,000 for fiscal year 2001, and such sums as may be 
necessary for each the fiscal years 2002 through [2005] 2010.
    [(j)] (m) * * *

           *       *       *       *       *       *       *


            Part F--Interagency Program for Trauma Research


SEC. 1261. ESTABLISHMENT OF PROGRAM.

    (a) In General.--* * *

           *       *       *       *       *       *       *

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

           *       *       *       *       *       *       *

          (4) * * *
                  (A) * * *

           *       *       *       *       *       *       *

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

           *       *       *       *       *       *       *

    (i) 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, and such sums as may be 
necessary for each of fiscal years 2007 through 2010.

           *       *       *       *       *       *       *


                                  
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