[House Report 110-567]
[From the U.S. Government Publishing Office]



110th Congress                                                   Report
                        HOUSE OF REPRESENTATIVES
 2d Session                                                     110-567

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



 
                   TRAUMATIC BRAIN INJURY ACT OF 2008

                                _______
                                

 April 8, 2008.--Committed to the Committee of the Whole House on the 
              State of the Union and ordered to be printed

                                _______
                                

 Mr. Dingell, from the Committee on Energy and Commerce, submitted the 
                               following

                              R E P O R T

                        [To accompany H.R. 1418]

      [Including cost estimate of the Congressional Budget Office]

  The Committee on Energy and Commerce, to whom was referred 
the bill (H.R. 1418) to provide for the expansion and 
improvement of traumatic brain injury programs, having 
considered the same, report favorably thereon with an amendment 
and recommend that the bill as amended do pass.

                                CONTENTS

                                                                   Page
Amendment........................................................     1
Purpose and Summary..............................................     4
Background and Need for Legislation..............................     4
Hearings.........................................................     5
Committee Consideration..........................................     5
Committee Votes..................................................     5
Committee Oversight Findings.....................................     5
Statement of General Performance Goals and Objectives............     5
New Budget Authority, Entitlement Authority, and Tax Expenditures     5
Earmarks and Tax and Tariff Benefits.............................     6
Committee Cost Estimate..........................................     6
Congressional Budget Office Estimate.............................     6
Federal Mandates Statement.......................................     8
Advisory Committee Statement.....................................     8
Constitutional Authority Statement...............................     8
Applicability to Legislative Branch..............................     8
Section-by-Section Analysis of the Legislation...................     8
Changes in Existing Law Made by the Bill, as Reported............    10

                               Amendment

  The amendment is as follows:
  Strike all after the enacting clause and insert the 
following:

SECTION 1. SHORT TITLE.

  This Act may be cited as the ``Traumatic Brain Injury Act of 2008''.

SEC. 2. CONFORMING AMENDMENTS RELATING TO RESTRUCTURING.

  Part J of title III of the Public Health Service Act (42 U.S.C. 280b 
et seq.) is amended--
          (1) by redesignating the section 393B (42 U.S.C. 280b-1c) 
        relating to the use of allotments for rape prevention 
        education, as section 393A and moving such section so that it 
        follows section 393;
          (2) by redesignating existing section 393A (42 U.S.C. 280b-
        1b) relating to prevention of traumatic brain injury, as 
        section 393B; and
          (3) by redesignating the section 393B (42 U.S.C. 280b-1d) 
        relating to traumatic brain injury registries, as section 393C.

SEC. 3. TRAUMATIC BRAIN INJURY PROGRAMS OF THE CENTERS FOR DISEASE 
                    CONTROL AND PREVENTION.

  (a) Prevention of Traumatic Brain Injury.--Clause (ii) of section 
393B(b)(3)(A) of the Public Health Service Act, as so redesignated, (42 
U.S.C. 280b-1b) is amended by striking ``from hospitals and trauma 
centers'' and inserting ``from hospitals and emergency departments''.
  (b) National Program for Traumatic Brain Injury Surveillance and 
Registries.--Section 393C of the Public Health Service Act, as so 
redesignated, (42 U.S.C. 280b et seq.) is amended--
          (1) in the section heading, by inserting ``surveillance and'' 
        after ``national program for traumatic brain injury''; and
          (2) in subsection (a), in the matter preceding paragraph (1), 
        by striking ``may make grants'' and all that follows through 
        ``to collect data concerning--'' and inserting ``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--''.
  (c) Report.--Section 393C of the Public Health Service Act (as so 
redesignated) is amended by adding at the end the following:
  ``(b) Not later than 18 months after the date of enactment of the 
Traumatic Brain Injury Act of 2008, the Secretary, acting through the 
Director of the Centers for Disease Control and Prevention and the 
Director of the National Institutes of Health and in consultation with 
the Secretary of Defense and the Secretary of Veterans Affairs, shall 
submit to the relevant committees of Congress a report that contains 
the findings derived from an evaluation concerning activities and 
procedures that can be implemented by the Centers for Disease Control 
and Prevention to improve the collection and dissemination of 
compatible epidemiological studies on the incidence and prevalence of 
traumatic brain injury in those with traumatic brain injury who were 
formerly in the military. The report shall include recommendations on 
the manner in which such agencies can further collaborate on the 
development and improvement of traumatic brain injury diagnostic tools 
and treatments.''.

SEC. 4. STUDY ON TRAUMATIC BRAIN INJURY.

  Part J of title III of the Public Health Service Act (42 U.S.C. 280b 
et seq.) is amended by inserting after section 393C, as so 
redesignated, the following:

``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 in consultation with the Director of the National Institutes of 
Health and other appropriate entities with respect to paragraphs (2), 
(3), and (4), may 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 and the clinical aspects of the disability 
                in all age groups and racial and ethnic minority 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) Identifying interventions and therapies that can 
        prevent or remediate the development of secondary neurologic 
        conditions related to traumatic brain injury.
          ``(4) Developing practice guidelines for the rehabilitation 
        of traumatic brain injury at such time as appropriate 
        scientific research becomes available.
  ``(b) Dates Certain for Reports.--If the study is conducted under 
subsection (a), the Secretary shall, not later than 3 years after the 
date of the enactment of the Traumatic Brain Injury Act of 2008, submit 
to Congress a report describing findings made as a result of carrying 
out such 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 including near drowning. The Secretary may revise 
the definition of such term as the Secretary determines necessary.''.

SEC. 5. TRAUMATIC BRAIN INJURY PROGRAMS OF THE NATIONAL INSTITUTES OF 
                    HEALTH.

  Section 1261 of the Public Health Service Act (42 U.S.C. 300d-61) is 
amended--
          (1) in subsection (b)(2), by striking ``Labor and Human 
        Resources'' and inserting ``Health, Education, Labor, and 
        Pensions'';
          (2) in subparagraph (D) of subsection (d)(4), by striking 
        ``head brain injury'' and inserting ``brain injury''; and
          (3) in subsection (i), by inserting ``, and such sums as may 
        be necessary for each of the fiscal years 2009 through 2012'' 
        before the period at the end.

SEC. 6. TRAUMATIC BRAIN INJURY PROGRAMS OF THE HEALTH RESOURCES AND 
                    SERVICES ADMINISTRATION.

  (a) State Grants for Demonstration Projects Regarding Traumatic Brain 
Injury.--Section 1252 of the Public Health Service Act (42 U.S.C. 300d-
52) is amended--
          (1) in subsection (a)--
                  (A) by striking ``may make grants to States'' and 
                inserting ``may make grants to States and American 
                Indian consortia''; and
                  (B) by striking ``health and other services'' and 
                inserting ``rehabilitation and other services'';
          (2) in subsection (b)--
                  (A) in paragraphs (1), (3)(A)(i), (3)(A)(iii), and 
                (3)(A)(iv), by striking the term ``State'' each place 
                such term appears and inserting the term ``State or 
                American Indian consortium''; and
                  (B) in paragraph (2), by striking ``recommendations 
                to the State'' and inserting ``recommendations to the 
                State or American Indian consortium'';
          (3) in subsection (c)(1), by striking the term ``State'' each 
        place such term appears and inserting ``State or American 
        Indian consortium'';
          (4) in subsection (e), by striking ``A State that received'' 
        and all that follows through the period and inserting ``A State 
        or American Indian consortium that received a grant under this 
        section prior to the date of the enactment of the Traumatic 
        Brain Injury Act of 2008 may complete the activities funded by 
        the grant.'';
          (5) in subsection (f)--
                  (A) in the subsection heading, by inserting ``and 
                American Indian Consortium'' after ``State'';
                  (B) in paragraph (1) in the matter preceding 
                subparagraph (A), paragraph (1)(E), paragraph (2)(A), 
                paragraph (2)(B), paragraph (3) in the matter preceding 
                subparagraph (A), paragraph (3)(E), and paragraph 
                (3)(F), by striking the term ``State'' each place such 
                term appears and inserting ``State or American Indian 
                consortium''; and
                  (C) in clause (ii) of paragraph (1)(A), by striking 
                ``children and other individuals'' and inserting 
                ``children, youth, and adults'';
          (6) in subsection (h)--
                  (A) by striking ``Not later than 2 years after the 
                date of the enactment of this section, the Secretary'' 
                and inserting ``Not less than biennially, the 
                Secretary'';
                  (B) by striking ``Commerce of the House of 
                Representatives, and to the Committee on Labor and 
                Human Resources'' and inserting ``Energy and Commerce 
                of the House of Representatives, and to the Committee 
                on Health, Education, Labor, and Pensions''; and
                  (C) by inserting ``and section 1253'' after 
                ``programs established under this section,'';
          (7) by amending subsection (i) to read as follows:
  ``(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 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.''; and
          (8) in subsection (j), by inserting ``, and such sums as may 
        be necessary for each of the fiscal years 2009 through 2012'' 
        before the period.
  (b) State Grants for Protection and Advocacy Services.--Section 1253 
of the Public Health Service Act (42 U.S.C. 300d-53) is amended--
          (1) in subsections (d) and (e), by striking the term 
        ``subsection (i)'' each place such term appears and inserting 
        ``subsection (l)'';
          (2) in subsection (g), by inserting ``each fiscal year not 
        later than October 1,'' before ``the Administrator shall pay'';
          (3) by redesignating subsections (i) and (j) as subsections 
        (l) and (m), respectively;
          (4) by inserting after subsection (h) the following:
  ``(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 purposes of 
providing services under subtitle C of the Developmental Disabilities 
Assistance and Bill of Rights Act of 2000.''; and
          (5) in subsection (l) (as redesignated by this subsection) by 
        striking ``2002 through 2005'' and inserting ``2009 through 
        2012''.

                          Purpose and Summary

    The purpose of H.R. 1418, the ``Traumatic Brain Injury Act 
of 2008'', is to authorize research and public health 
activities related to trauma and traumatic brain injury.

                  Background and Need for Legislation

    Traumatic brain injuries (TBIs) are caused by sudden jolts, 
blows, or penetrating head traumas that disrupt brain function. 
Although a traumatic brain injury can happen to anyone, young 
children, teenaged boys, elderly persons, and military 
personnel are especially at risk.
    According to the Centers for Disease Control and Prevention 
(CDC), of the 1.5 million Americans who sustain a TBI each 
year, around 50,000 die and another 80,000 to 90,000 experience 
long-term or lifelong disabilities as a result. Traumatic brain 
injuries can result in disability and the need for help to 
perform daily living activities.
    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 has 
increased the overall visibility of TBI. More work, however, 
needs to be done at both the national and State levels to build 
an effective, durable service system that meets the needs of 
individuals with TBI.

                                Hearings

    There were no hearings held in connection to the bill 
reported by the Committee.

                        Committee Consideration

    Tuesday, March 11, 2008, the Subcommittee on Health met in 
open markup session and favorably forwarded H.R. 1418, amended, 
to the full Committee for consideration, by a voice vote. On 
Thursday, March 13, 2008, the full Committee met in open markup 
session and ordered H.R. 1418 favorably reported to the House, 
as amended by the Subcommittee on Health, by a voice vote. No 
amendments were offered during full Committee consideration.

                            Committee Votes

    Clause 3(b) of rule XIII of the Rules of the House of 
Representatives requires the Committee to list the record votes 
on the motion to report legislation and amendments thereto. 
There were no record votes taken on amendments or in connection 
with ordering H.R. 1418 reported to the House. A motion by Mr. 
Dingell to order H.R. 1418 favorably reported to the House, as 
amended, was agreed to by a voice vote.

                      Committee Oversight Findings

    Regarding clause 3(c)(1) of rule XIII of the Rules of the 
House of Representatives, the oversight findings of the 
Committee regarding H.R. 1418 are reflected in this report.

         Statement of General Performance Goals and Objectives

    The objective of H.R. 1418 is to expand and improve TBI 
programs to reduce the incidence of TBI through basic and 
applied research, public education, injury surveillance, and 
demonstration projects to improve protection and advocacy 
systems.

   New Budget Authority, Entitlement Authority, and Tax Expenditures

    Regarding compliance with clause 3(c)(2) of rule XIII of 
the Rules of the House of Representatives, the Committee finds 
that H.R. 1418 would result in no new or increased budget 
authority, entitlement authority, or tax expenditures or 
revenues.

                  Earmarks and Tax and Tariff Benefits

    Regarding compliance with clause 9 of rule XXI of the Rules 
of the House of Representatives, H.R. 1418 does not contain any 
congressional earmarks, limited tax benefits, or limited tariff 
benefits as defined in clause 9(d), 9(e), or 9(f) of rule XXI.

                        Committee Cost Estimate

    The Committee adopts as its own the cost estimate on H.R. 
1418 prepared by the Director of the Congressional Budget 
Office pursuant to section 402 of the Congressional Budget Act 
of 1974.

                  Congressional Budget Office Estimate

    Pursuant to clause 3(c)(3) of rule XIII of the Rules of the 
House of Representatives, the following is the cost estimate on 
H.R. 1418 provided by the Congressional Budget Office pursuant 
to section 402 of the Congressional Budget Act of 1974:

                                     U.S. Congress,
                               Congressional Budget Office,
                                     Washington, DC, April 7, 2008.
Hon. John D. Dingell,
Chairman, Committee on Energy and Commerce,
House of Representatives, Washington, DC.
    Dear Mr. Chairman: The Congressional Budget Office has 
prepared the enclosed cost estimate for H.R. 1418, the 
Traumatic Brain Injury Act of 2008.
    If you wish further details on this estimate, we will be 
pleased to provide them. The CBO staff contacts are Sarah 
Evans, Tim Gronniger, and Lara Robillard.
            Sincerely,
                                         Robert A. Sunshine
                                   (For Peter R. Orszag, Director).

H.R. 1418--Traumatic Brain Injury Act of 2008

    Summary: H.R. 1418 would amend the Public Health Services 
Act to authorize research and public health activities related 
to trauma and traumatic brain injury (TBI). CBO estimates that 
implementing the bill would cost $117 million in 2009 and $1.6 
billion over the 2009-2013 period, subject to the appropriation 
of the necessary amounts. Enacting H.R. 1418 would not affect 
direct spending or federal revenues.
    H.R. 1418 contains no intergovernmental or private-sector 
mandates as defined in the Unfunded Mandates Reform Act (UMRA); 
any costs to state governments and Indian consortia would 
result from complying with conditions of federal assistance.
    Estimated cost to the Federal Government: The estimated 
budgetary impact of H.R. 1418 is shown in the following table. 
The costs of this legislation fall within budget function 550 
(health).


----------------------------------------------------------------------------------------------------------------
                                                                     By fiscal year, in millions of dollars--
                                                                 -----------------------------------------------
                                                                   2008    2009    2010    2011    2012    2013
----------------------------------------------------------------------------------------------------------------
                                        SPENDING SUBJECT TO APPROPRIATION

Spending Under Current Law:
    Budget Authority\1\.........................................     391       0       0       0       0       0
    Estimated Outlays...........................................     402     279      60       9       0       0
Proposed Changes:
    Estimated Authorization Level\1\............................       0     398     405     413     423       6
    Estimated Outlays...........................................       0     117     338     398     411     295
Spending Under H.R. 1418:
    Estimated Authorization Level\1\............................     391     398     405     413     423       6
    Estimated Outlays...........................................     402     396     399     407     411     295
----------------------------------------------------------------------------------------------------------------
\1\The 2008 level is the amount appropriated for that year for research and other federal activities related to
  traumatic brain injury.

    Basis of estimate: H.R. 1418 would authorize funding for 
research, treatment, surveillance, and education activities 
related to trauma and traumatic brain injury at the National 
Institutes of Health (NIH), the Health Resources and Services 
Administration (HRSA), and the Centers for Disease Control and 
Prevention (CDC). CBO estimates that those activities would 
require the appropriation of $398 million in 2009 and $1.6 
billion over the 2009-2013 period. Assuming the appropriation 
of necessary amounts, CBO estimates that implementing H.R. 1418 
would cost $117 million in 2009 and $1.6 billion over the 2009-
2013 period.
    The NIH estimates that it will allocate $376 million for 
trauma-related activities in fiscal year 2008. H.R. 1418 would 
authorize the appropriation of such sums as are necessary for 
those activities over the 2009-2012 period. Based on historical 
program expenditures at NIH and adjusting for inflation, CBO 
estimates that NIH would require the appropriation of $383 
million for 2009 and $1.6 billion over the 2009-2013 period to 
conduct the specified activities. Implementing those programs 
would cost $111 million in 2009 and $1.5 billion over the 2009-
2013 period, assuming appropriation of the necessary amounts.
    HRSA allocated $9 million in 2008 for grants to states to 
expand access to care and protection services for TBI. H.R. 
1418 would authorize the appropriation of such sums as are 
necessary for those activities over the 2009-2012 period, and 
would expand the program to allow consortia of American Indians 
to receive such grants. Based on historical spending of those 
programs, CBO estimates that the agency would require the 
appropriation of $9 million in 2009 and $37 million over the 
2009-2012 period to carry out activities specified by the bill. 
CBO estimates that implementing those provisions of H.R. 1418 
would cost $3 million in 2009 and $24 million over the 2009-
2013 period, assuming that the necessary amounts are 
appropriated and that future rates of spending resemble 
historical patterns for similar activities.
    In 2008, the Centers for Disease Control and Prevention 
allocated $6 million for TBI-related activities, including 
grants to states' TBI surveillance programs and educational 
activities. H.R. 1418 would authorize the appropriation of 
necessary amounts for those and other TBI-related activities, 
which CBO estimates would require $6 million in 2009 and $30 
million over the 2009-2013 period. Based on historical spending 
patterns for those activities, and assuming appropriation of 
the necessary amounts, CBO estimates that implementing H.R. 
1418's CDC provisions would cost $3 million in 2009 and $26 
million over the 2009-2013 period.
    Intergovernmental and private-sector impact: H.R. 1418 
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.
    Previous CBO estimates: On July 23, 2007, CBO transmitted a 
cost estimate for S. 793, the Traumatic Brain Injury 
Reauthorization Act of 2007, as ordered reported by the Senate 
Committee on Health, Education, Labor, and Pensions on June 27, 
2007. The two bills are very similar, except that S. 793 would 
authorize appropriations for the activities administered by 
HRSA and NIH for the 2008-2011 period (rather than the 2009-
2012 period specified in H.R. 1418). CBO's estimate for H.R. 
1418 differs from that for S. 793 because the authorized 
periods differ, and because the estimate for H.R. 1418 takes 
into account funding appropriated for fiscal year 2008 for TBI-
related activities.
    Estimate prepared by: Federal Costs: Sarah Evans, Tim 
Gronniger, and Lara Robillard. Impact on State, Local, and 
Tribal Governments: Lisa Ramirez-Branum. Impact on the Private 
Sector: Patrick Bernhardt.
    Estimate approved by: Keith J. Fontenot, Deputy Assistant 
Director for Health and Human Resources, Budget Analysis 
Division.

                       Federal Mandates Statement

    The Committee adopts as its own the estimate of Federal 
mandates regarding H.R. 1418 prepared by the Director of the 
Congressional Budget Office pursuant to section 423 of the 
Unfunded Mandates Reform Act.

                      Advisory Committee Statement

    No advisory committees within the meaning of section 5(b) 
of the Federal Advisory Committee Act would be created by H.R. 
1418.

                   Constitutional Authority Statement

    Pursuant to clause 3(d)(1) of rule XIII of the Rules of the 
House of Representatives, the Committee finds that the 
Constitutional authority for H.R. 1418 is provided in the 
provisions of Article I, section 8, clause 1, that relate to 
expending funds to provide for the general welfare of the 
United States.

                  Applicability to Legislative Branch

    The Committee finds that H.R. 1418 does not relate to the 
terms and conditions of employment or access to public services 
or accommodations within the meaning of section 102(b)(3) of 
the Congressional Accountability Act of 1995.

             Section-by-Section Analysis of the Legislation


Section 1. Short title

    Section 1 specifies the short title of the legislation as 
the ``Reauthorization of the Traumatic Brain Injury Act''.

Section 2. Conforming amendments relating to restructuring

    Section 2 re-designates section 393B as section 393A, 
section 393A as section 393B, and section 393B as section 393C, 
so that sections pertaining to TBI follow and are not 
interrupted by the other provisions of the Public Health 
Service Act (PHSA).

Section 3. Traumatic brain injury programs of the Centers for Disease 
        Control and Prevention

    Section 3 amends part J of Title III of the PHSA as re-
designated (42 U.S.C. 280b-1b) authorize the dissemination of 
information related to TBI and its secondary conditions upon an 
individual's discharge from hospitals and emergency centers.
    Section 393C of the PHSA, as re-designated (42 U.S.C. 280B 
et seq.), is amended to change the section heading to the 
`National Program for Brain Injury Surveillance and 
Registries.' 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 of the Department of Health and Human 
Services (Secretary) is authorized to ensure the uniformity of 
reporting information. It also ensures that individuals with a 
TBI are linked with academic institutions to conduct applied 
research that will support the development of such surveillance 
systems and registries as necessary.
    This section directs the Secretary, acting through the CDC 
and the National Institutes of Health (NIH), in consultation 
with the Department of Defense and Department of Veterans 
Affairs, to study and report on methods of improving data 
collection and collaboration between civilian and military 
registries, to include the development of diagnostic tools and 
treatments for traumatic brain injuries, within 18 months of 
enactment of the Act. It is not the intent of the legislation 
to in any way inhibit or supplant the ongoing efforts at the 
Departments of Veterans Affairs and Defense in the research, 
prevention, and treatment of Traumatic Brain Injury. This 
legislation would supplement and compliment the Federal efforts 
already underway to address TBI in our Nation's veterans and 
service members.

Section 4. Study of traumatic brain injury

    Section 4 authorizes the CDC to conduct a study in 
consultation with NIH to examine aspects of TBI, including 
determining the incidence and prevalence of TBI in all age 
groups; collecting, maintaining, and reporting national trends; 
identifying interventions used and that can be 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.

Section 5. Traumatic brain injury programs of the National Institutes 
        of Health

    Section 5 reauthorizes the current grant program for the 
conduct of 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 of the fiscal years 2008 through 2011.

Section 6. Traumatic brain injury programs of the Health Resources and 
        Services Administration

    Section 6 reauthorizes the Secretary to award grants to 
States, and authorizes the Secretary to award grants to the 
American Indian consortium, 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 biennially, a report 
describing the findings, and results of the programs 
established under this section.
    Definitions in this section include ``American Indian 
consortium'' and ``traumatic brain injury''.
    Grants are authorized for such sums as may be necessary for 
each of the fiscal years 2008 through 2011.
    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 and it 
directs those grants to be awarded directly to any protection 
and advocacy system that complies with the provisions of this 
section, no later than October 1 each fiscal year.
    This section requires the Administrator of the Health 
Resources and Services 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 clarifies that protection and advocacy systems 
are allowed 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, including the authority to pursue legal, administrative, 
and other appropriate remedies or approaches to ensure that 
protection of, and advocacy for, the rights of such individuals 
with a TBI and the authority to provide information and 
referral programs and services that address the needs of 
individuals with traumatic brain injury.

         Changes in Existing Law Made by the Bill, as Reported

    In compliance with clause 3(e) of rule XIII of the Rules of 
the House of Representatives, changes in existing law made by 
the bill, as reported, are shown as follows (existing law 
proposed to be omitted is enclosed in black brackets, new 
matter is printed in italic, existing law in which no change is 
proposed is shown in roman):

PUBLIC HEALTH SERVICE ACT

           *       *       *       *       *       *       *



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

           *       *       *       *       *       *       *



Part J--Prevention and Control of Injuries

           *       *       *       *       *       *       *



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

  (a) * * *

           *       *       *       *       *       *       *


                  PREVENTION OF TRAUMATIC BRAIN INJURY

  Sec. [393A.] 393B. (a) * * *
  (b) Certain Activities.--Activities under subsection (a) may 
include--
          (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) * * *
                          (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--
          (1) * * *

           *       *       *       *       *       *       *

  (b) Not later than 18 months after the date of enactment of 
the Traumatic Brain Injury Act of 2008, the Secretary, acting 
through the Director of the Centers for Disease Control and 
Prevention and the Director of the National Institutes of 
Health and in consultation with the Secretary of Defense and 
the Secretary of Veterans Affairs, shall submit to the relevant 
committees of Congress a report that contains the findings 
derived from an evaluation concerning activities and procedures 
that can be implemented by the Centers for Disease Control and 
Prevention to improve the collection and dissemination of 
compatible epidemiological studies on the incidence and 
prevalence of traumatic brain injury in those with traumatic 
brain injury who were formerly in the military. The report 
shall include recommendations on the manner in which such 
agencies can further collaborate on the development and 
improvement of traumatic brain injury diagnostic tools and 
treatments.

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 in consultation with the Director of the 
National Institutes of Health and other appropriate entities 
with respect to paragraphs (2), (3), and (4), may 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 and the clinical 
                aspects of the disability in all age groups and 
                racial and ethnic minority 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) Identifying interventions and therapies that can 
        prevent or remediate the development of secondary 
        neurologic conditions related to traumatic brain 
        injury.
          (4) Developing practice guidelines for the 
        rehabilitation of traumatic brain injury at such time 
        as appropriate scientific research becomes available.
  (b) Dates Certain for Reports.--If the study is conducted 
under subsection (a), the Secretary shall, not later than 3 
years after the date of the enactment of the Traumatic Brain 
Injury Act of 2008, submit to Congress a report describing 
findings made as a result of carrying out such 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 including 
near drowning. The Secretary may revise the definition of such 
term as the Secretary determines necessary.

           *       *       *       *       *       *       *


TITLE XII--TRAUMA CARE

           *       *       *       *       *       *       *


Part E--Miscellaneous Programs

           *       *       *       *       *       *       *


SEC. 1252. STATE GRANTS FOR 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;

           *       *       *       *       *       *       *

                          (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 the 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.

           *       *       *       *       *       *       *

  (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.] A State or American Indian 
consortium that received a grant under this section prior to 
the date of the enactment of the Traumatic Brain Injury Act of 
2008 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) To develop, change, or enhance community-
                based service delivery systems that include 
                timely access to comprehensive appropriate 
                services and supports. Such service and 
                supports--
                          (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--
                  (A) * * *

           *       *       *       *       *       *       *

                  (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 
biennially, the Secretary shall submit to the Committee on 
[Commerce of the House of Representatives, and to the Committee 
on Labor and Human Resources] Energy and Commerce of the House 
of Representatives, and to the Committee on Health, Education, 
Labor, and Pensions of the Senate, a report describing the 
findings and results of the programs established under this 
section, and section 1253 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 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.
  (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 2009 through 2012.

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

  (a) * * *

           *       *       *       *       *       *       *

  (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.

           *       *       *       *       *       *       *

  (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.

           *       *       *       *       *       *       *

          (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 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.

           *       *       *       *       *       *       *

  (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 purposes 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] 2009 
through 2012.
  [(j)] (m) Definitions.--In this section:
          (1) * * *

           *       *       *       *       *       *       *


            Part F--Interagency Program for Trauma Research

SEC. 1261. ESTABLISHMENT OF PROGRAM.

  (a) * * *
  (b) Plan for Program.--
          (1) * * *
          (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] Health, Education, 
        Labor, and Pensions of the Senate, together with an 
        estimate of the funds needed for each of the fiscal 
        years 1994 through 1996 to implement the plan.

           *       *       *       *       *       *       *

  (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) * * *

           *       *       *       *       *       *       *

                  (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 the fiscal years 2009 through 2012.

           *       *       *       *       *       *       *


                                  
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