[House Report 110-569]
[From the U.S. Government Publishing Office]



110th Congress                                                   Report
                        HOUSE OF REPRESENTATIVES
 2d Session                                                     110-569

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



 
                     SAFETY OF SENIORS 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. 3701]

      [Including cost estimate of the Congressional Budget Office]

    The Committee on Energy and Commerce, to whom was referred 
the bill (H.R. 3701) to amend the Public Health Service Act to 
direct the Secretary of Health and Human Services to intensify 
programs with respect to research and related activities 
concerning falls among older adults, 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..............................................     3
Background and Need for Legislation..............................     3
Hearings.........................................................     4
Committee Consideration..........................................     4
Committee Votes..................................................     4
Committee Oversight Findings.....................................     4
Statement of General Performance Goals and Objectives............     4
New Budget Authority, Entitlement Authority, and Tax Expenditures     5
Earmarks and Tax and Tariff Benefits.............................     5
Committee Cost Estimate..........................................     5
Congressional Budget Office Estimate.............................     5
Federal Mandates Statement.......................................     6
Advisory Committee Statement.....................................     6
Constitutional Authority Statement...............................     6
Applicability to Legislative Branch..............................     6
Section-by-Section Analysis of the Legislation...................     6
Changes in Existing Law Made by the Bill, as Reported............     8

                               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 ``Safety of Seniors Act of 2008''.

SEC. 2. AMENDMENTS TO THE PUBLIC HEALTH SERVICE ACT.

  Part J of title III of the Public Health Service Act (42 U.S.C. 280b 
et seq.) is amended--
          (1) by redesignating section 393B (as added by section 1401 
        of Public Law 106-386) as section 393C and transferring such 
        section so that it appears after section 393B (as added by 
        section 1301 of Public Law 106-310); and
          (2) by inserting after section 393C (as redesignated by 
        paragraph (1)) the following:

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

  ``(a) Public Education.--The Secretary may--
          ``(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, specializing, or 
        demonstrating expertise, in falls or fall prevention, 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 may--
                  ``(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, specializing, or 
        demonstrating expertise, in falls or fall prevention, may 
        provide professional education for physicians and allied health 
        professionals, and aging service providers in fall prevention, 
        evaluation, and management.
  ``(c) Demonstration Projects.--The Secretary may 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, 
        specializing, or demonstrating expertise, in falls or fall 
        prevention, 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, specializing, or 
        demonstrating expertise, in falls or fall prevention, 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, 
        specializing, or demonstrating expertise, in falls or fall 
        prevention, 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, 
        specializing, or demonstrating expertise, in falls or fall 
        prevention, to conduct evaluations of the effectiveness of the 
        demonstration projects described in this subsection.
  ``(d) Priority.--In awarding grants, contracts, or cooperative 
agreements under this section, the Secretary may give priority to 
entities that explore the use of cost-sharing with respect to 
activities funded under the grant, contract, or agreement to ensure the 
institutional commitment of the recipients of such assistance to the 
projects funded under the grant, contract, or agreement. Such non-
Federal cost sharing contributions may be provided directly or through 
donations from public or private entities and may be in cash or in-
kind, fairly evaluated, including plant, equipment, or services.
  ``(e) Study of Effects of Falls on Health Care Costs.--
          ``(1) In general.--The Secretary may 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.--If the Secretary conducts the review under 
        paragraph (1), the Secretary shall, not later than 36 months 
        after the date of enactment of the Safety of Seniors Act of 
        2008, submit to Congress a report describing the findings of 
        the Secretary in conducting such review.''.

                          Purpose and Summary

    The purpose of H.R. 3701, the ``Safety of Seniors Act of 
2008'', is to amend the Public Health Service Act to direct the 
Secretary of Health and Human Services (HHS) to expand programs 
with respect to research and related activities concerning 
falls among older adults.

                  Background and Need for Legislation

    Falls represent a serious health risk for millions of older 
Americans. In the United States, one of every three persons age 
65 or older falls each year. Falls are the leading cause of 
injury deaths and the most common cause of injuries and 
hospital admissions for trauma in older adults. According to 
the Centers for Disease Control and Prevention (CDC), in 2002, 
more than 12,800 people aged 65 and older died from fall-
related injuries and more than 1.6 million seniors were treated 
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 traumatic brain injury as a result of a fall.
    In addition to their effect on the quality of life of 
seniors and their families, falls also contribute to rising 
healthcare costs due to increased physician visits, emergency 
room use, and hospitalization. According to the CDC, the direct 
medical cost totaled $179 million for fatal and $19 billion for 
nonfatal fall injuries in 2000.
    To address the effect of falls on seniors, their families, 
and healthcare costs, H.R. 3701 would focus ongoing Federal 
efforts to prevent falls among older adults by developing a 
national education campaign to reduce falls among older adults, 
by enhancing services and conducting research to determine the 
most effective approaches to preventing and treating falls 
among older adults, and by urging the Secretary of HHS to 
evaluate the effect of falls on healthcare costs, the potential 
for reducing falls, and the most effective strategies for 
reducing healthcare costs associated with falls.

                                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. 3701, 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. 3701 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. 3701 reported to the House. A motion by Mr. 
Dingell to order H.R. 3701 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. 3701 are reflected in this report.

         Statement of General Performance Goals and Objectives

    The objective of H.R. 3701 is to amend the Public Health 
Service Act to authorize the Secretary of HHS to oversee and 
support a national education campaign focusing on reducing 
falls among older adults and preventing repeat falls and to 
award grants, contracts, or cooperative agreements to design 
and carry out local education campaigns. Specifically, the 
legislation directs HHS to (1) develop public education 
programs on fall prevention for the elderly, family members, 
caregivers, and others involved with the elderly; (2) enhance 
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 healthcare costs, the 
potential for reducing falls, and the most effective strategies 
for reducing healthcare costs associated with falls.

   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. 3701 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. 3701 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. 
3701 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. 3701 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 4, 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. 3701, the Safety 
of Seniors Act of 2008.
    If you wish further details on this estimate, we will be 
pleased to provide them. The CBO staff contact is Mindy Cohen.
            Sincerely,
                                         Robert A. Sunshine
                                   (For Peter R. Orszag, Director).
    Enclosure.

H.R. 3701--Safety of Seniors Act of 2008

    H.R. 3701 would modify the Public Health Service Act to 
authorize funding for programs to detect, prevent, and treat 
injuries due to falls among older adults. The bill would also 
direct the Secretary of Health and Human Services and the 
Centers for Disease Control and Prevention to undertake 
research, education, and other activities aimed at reducing the 
extent and effect of falls among older adults.
    Based on historical spending patterns for similar 
activities, CBO estimates that implementing H.R. 3701 would 
cost $1 million in 2009 and $13 million over the 2009-2013 
period, assuming the availability of appropriated funds. 
Enacting H.R. 3701 would not affect direct spending or 
receipts.
    H.R. 3701 contains no intergovernmental or private-sector 
mandates as defined in the Unfunded Mandates Reform Act.
    The estimated budgetary impact of H.R. 3701 is shown in the 
following table. The costs of this legislation fall within 
budget function 550 (health).

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

Estimated Authorization Level...       3       3       3       3       3
Estimated Outlays...............       1       3       3       3       3
------------------------------------------------------------------------

    The CBO staff contacts for this estimate are Tim Gronniger 
and Mindy Cohen. This estimate was 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. 3701 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. 
3701.

                   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. 3701 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. 3701 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 establishes the short title of the Act as the 
``Safety of Seniors Act of 2008''.

Section 2. Amendments to the Public Health Service Act

    Section 2 of this legislation amends Part J of title III of 
the Public Health Service Act (42 U.S.C. 280b et seq.) to add a 
new section 393D, Prevention of Falls Among Older Adults. 
Section 2 authorizes the Secretary of HHS to establish a 
national public education campaign to reduce falls among older 
adults and prevent repeat falls. It also establishes authority 
for the Secretary of HHS to make grants or enter into contracts 
or cooperative agreements to assist State-level coalitions in 
conducting local education campaigns to reduce falls and 
prevent repeat falls among older adults.
    Section 2 authorizes the Secretary of 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 among older 
adults; tailoring proven fall reduction strategies to specific 
populations of older adults; improving diagnosis, treatment, 
and rehabilitation of older adults who have fallen and those at 
high risk for falls; and assessing the risk of falls occurring 
in various settings.
    Section 2 authorizes the Secretary of HHS to conduct 
research concerning barriers to adopting proven fall prevention 
methods; developing, implementing, and evaluating the most 
effective approaches to reducing falls among high-risk older 
adults living in community settings, including long-term care 
and assisted living facilities; and evaluating the 
effectiveness of community programs designed to prevent falls 
among older adults. It also authorizes the Secretary of HHS 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.
    Section 2 authorizes the Secretary of HHS to oversee and 
support demonstration programs carried out by qualified 
organizations, institutions, or a consortium of qualified 
organizations to conduct the following (1) a multistate 
demonstration project assessing the utility of targeted fall-
risk screening and referral programs; (2) programs that use 
multiple approaches to prevent falls; (3) programs targeting 
newly discharged fall victims at high risk for second falls; 
and (4) private sector and public-private partnerships to 
develop technology to prevent falls and prevent or reduce fall-
related injuries.
    Section 2 authorizes the Secretary of HHS to award grants, 
contracts, or cooperative agreements to design, implement, and 
evaluate fall prevention programs using proven intervention 
strategies in residential and institutional settings; and, to 
carry out a multistate demonstration project to implement and 
evaluate fall prevention programs using these strategies for 
single and multifamily residences with high concentrations of 
older adults. This section also authorizes the Secretary of HHS 
to award grants, contracts, or cooperative agreements to 
conduct evaluations of the effectiveness of the demonstration 
projects in this section.
    Section 2 authorizes the Secretary of HHS to review the 
effects of falls on healthcare costs, the potential for 
reducing falls, and the most effective strategies for reducing 
fall-related healthcare costs. If such review is conducted, the 
Secretary is required to submit a report to Congress describing 
the findings. The report must be submitted no later than 36 
months after the date of the bill's enactment.

         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.] 393C. USE OF ALLOTMENTS FOR RAPE PREVENTION EDUCATION.

  (a) * * *

           *       *       *       *       *       *       *


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

  (a) Public Education.--The Secretary may--
          (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, 
        specializing, or demonstrating expertise, in falls or 
        fall prevention, 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 may--
                  (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, specializing, or demonstrating 
        expertise, in falls or fall prevention, may provide 
        professional education for physicians and allied health 
        professionals, and aging service providers in fall 
        prevention, evaluation, and management.
  (c) Demonstration Projects.--The Secretary may 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, specializing, or demonstrating 
        expertise, in falls or fall prevention, 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, 
        specializing, or demonstrating expertise, in falls or 
        fall prevention, 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, specializing, or demonstrating 
        expertise, in falls or fall prevention, 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, 
        specializing, or demonstrating expertise, in falls or 
        fall prevention, to conduct evaluations of the 
        effectiveness of the demonstration projects described 
        in this subsection.
  (d) Priority.--In awarding grants, contracts, or cooperative 
agreements under this section, the Secretary may give priority 
to entities that explore the use of cost-sharing with respect 
to activities funded under the grant, contract, or agreement to 
ensure the institutional commitment of the recipients of such 
assistance to the projects funded under the grant, contract, or 
agreement. Such non-Federal cost sharing contributions may be 
provided directly or through donations from public or private 
entities and may be in cash or in-kind, fairly evaluated, 
including plant, equipment, or services.
  (e) Study of Effects of Falls on Health Care Costs.--
          (1) In general.--The Secretary may 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.--If the Secretary conducts the review 
        under paragraph (1), the Secretary shall, not later 
        than 36 months after the date of enactment of the 
        Safety of Seniors Act of 2008, submit to Congress a 
        report describing the findings of the Secretary in 
        conducting such review.

           *       *       *       *       *       *       *


                                  
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