[House Report 110-77]
[From the U.S. Government Publishing Office]



110th Congress                                                   Report
                        HOUSE OF REPRESENTATIVES
 1st Session                                                     110-77

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



 
        TRAUMA CARE SYSTEMS PLANNING AND DEVELOPMENT ACT OF 2007

                                _______
                                

 March 27, 2007.--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. 727]

      [Including cost estimate of the Congressional Budget Office]

  The Committee on Energy and Commerce, to whom was referred 
the bill (H.R. 727) to amend the Public Health Service Act to 
add requirements regarding trauma care, and for other purposes, 
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..............................................     7
Background and Need for Legislation..............................     7
Hearings.........................................................     8
Committee Consideration..........................................     8
Committee Votes..................................................     8
Committee Oversight Findings.....................................     8
Statement of General Performance Goals and Objectives............     8
New Budget Authority, Entitlement Authority, and Tax Expenditures     9
Earmarks and Tax and Tariff Benefits.............................     9
Committee Cost Estimate..........................................     9
Congressional Budget Office Estimate.............................     9
Federal Mandates Statement.......................................    11
Advisory Committee Statement.....................................    11
Constitutional Authority Statement...............................    11
Applicability to Legislative Branch..............................    11
Section-by-Section Analysis of the Legislation...................    11
Changes in Existing Law Made by the Bill, as Reported............    13

                               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 ``Trauma Care Systems Planning and 
Development Act of 2007''.

SEC. 2. ESTABLISHMENT.

  Section 1201 of the Public Health Service Act (42 U.S.C. 300d) is 
amended to read as follows:

``SEC. 1201. ESTABLISHMENT.

  ``(a) In General.--The Secretary shall, with respect to trauma care--
          ``(1) conduct and support research, training, evaluations, 
        and demonstration projects;
          ``(2) foster the development of appropriate, modern systems 
        of such care through the sharing of information among agencies 
        and individuals involved in the study and provision of such 
        care;
          ``(3) collect, compile, and disseminate information on the 
        achievements of, and problems experienced by, State and local 
        agencies and private entities in providing trauma care and 
        emergency medical services and, in so doing, give special 
        consideration to the unique needs of rural areas;
          ``(4) provide to State and local agencies technical 
        assistance to enhance each State's capability to develop, 
        implement, and sustain the trauma care component of each 
        State's plan for the provision of emergency medical services;
          ``(5) sponsor workshops and conferences; and
          ``(6) promote the collection and categorization of trauma 
        data in a consistent and standardized manner.
  ``(b) Grants, Cooperative Agreements, and Contracts.--The Secretary 
may make grants, and enter into cooperative agreements and contracts, 
for the purpose of carrying out subsection (a).''.

SEC. 3. CLEARINGHOUSE ON TRAUMA CARE AND EMERGENCY MEDICAL SERVICES.

  The Public Health Service Act (42 U.S.C. 201 et seq.) is amended--
          (1) by striking section 1202; and
          (2) by redesignating section 1203 as section 1202.

SEC. 4. ESTABLISHMENT OF PROGRAMS FOR IMPROVING TRAUMA CARE IN RURAL 
                    AREAS.

  Section 1202 of the Public Health Service Act, as redesignated by 
section 3(2), is amended to read as follows:

``SEC. 1202. ESTABLISHMENT OF PROGRAMS FOR IMPROVING TRAUMA CARE IN 
                    RURAL AREAS.

  ``(a) In General.--The Secretary may make grants to public and 
nonprofit private entities for the purpose of carrying out research and 
demonstration projects with respect to improving the availability and 
quality of emergency medical services in rural areas--
          ``(1) by developing innovative uses of communications 
        technologies and the use of new communications technology;
          ``(2) by developing model curricula, such as advanced trauma 
        life support, for training emergency medical services 
        personnel, including first responders, emergency medical 
        technicians, emergency nurses and physicians, and paramedics--
                  ``(A) in the assessment, stabilization, treatment, 
                preparation for transport, and resuscitation of 
                seriously injured patients, with special attention to 
                problems that arise during long transports and to 
                methods of minimizing delays in transport to the 
                appropriate facility; and
                  ``(B) in the management of the operation of the 
                emergency medical services system;
          ``(3) by making training for original certification, and 
        continuing education, in the provision and management of 
        emergency medical services more accessible to emergency medical 
        personnel in rural areas through telecommunications, home 
        studies, providing teachers and training at locations 
        accessible to such personnel, and other methods;
          ``(4) by developing innovative protocols and agreements to 
        increase access to prehospital care and equipment necessary for 
        the transportation of seriously injured patients to the 
        appropriate facilities;
          ``(5) by evaluating the effectiveness of protocols with 
        respect to emergency medical services and systems; and
          ``(6) by increasing communication and coordination with State 
        trauma systems.
  ``(b) Special Consideration for Certain Rural Areas.--In making 
grants under subsection (a), the Secretary shall give special 
consideration to any applicant for the grant that will provide services 
under the grant in any rural area identified by a State under section 
1214(d)(1).
  ``(c) Requirement of Application.--The Secretary may not make a grant 
under subsection (a) unless an application for the grant is submitted 
to the Secretary and the application is in such form, is made in such 
manner, and contains such agreements, assurances, and information as 
the Secretary determines to be necessary to carry out this section.''.

SEC. 5. COMPETITIVE GRANTS.

  Part A of title XII of the Public Health Service Act, as amended by 
section 3, is amended by adding at the end the following:

``SEC. 1203. COMPETITIVE GRANTS FOR THE IMPROVEMENT OF TRAUMA CARE.

  ``(a) In General.--The Secretary, acting through the Administrator of 
the Health Resources and Services Administration, may make grants to 
States, political subdivisions, or consortia of States or political 
subdivisions for the purpose of improving access to and enhancing the 
development of trauma care systems.
  ``(b) Use of Funds.--The Secretary may make a grant under this 
section only if the applicant agrees to use the grant--
          ``(1) to integrate and broaden the reach of a trauma care 
        system, such as by developing innovative protocols to increase 
        access to prehospital care;
          ``(2) to strengthen, develop, and improve an existing trauma 
        care system;
          ``(3) to expand communications between the trauma care system 
        and emergency medical services through improved equipment or a 
        telemedicine system;
          ``(4) to improve data collection and retention; or
          ``(5) to increase education, training, and technical 
        assistance opportunities, such as training and continuing 
        education in the management of emergency medical services 
        accessible to emergency medical personnel in rural areas 
        through telehealth, home studies, and other methods.
  ``(c) Preference.--In selecting among States, political subdivisions, 
and consortia of States or political subdivisions for purposes of 
making grants under this section, the Secretary shall give preference 
to applicants that--
          ``(1) have developed a process, using national standards, for 
        designating trauma centers;
          ``(2) recognize protocols for the delivery of seriously 
        injured patients to trauma centers;
          ``(3) implement a process for evaluating the performance of 
        the trauma system; and
          ``(4) agree to participate in information systems described 
        in section 1202 by collecting, providing, and sharing 
        information.
  ``(d) Priority.--In making grants under this section, the Secretary 
shall give priority to applicants that will use the grants to focus on 
improving access to trauma care systems.
  ``(e) Special Consideration.--In awarding grants under this section, 
the Secretary shall give special consideration to projects that 
demonstrate strong State or local support, including availability of 
non-Federal contributions.''.

SEC. 6. REQUIREMENT OF MATCHING FUNDS FOR FISCAL YEARS SUBSEQUENT TO 
                    FIRST FISCAL YEAR OF PAYMENTS.

  Section 1212 of the Public Health Service Act (42 U.S.C. 300d-12) is 
amended to read as follows:

``SEC. 1212. REQUIREMENT OF MATCHING FUNDS FOR FISCAL YEARS SUBSEQUENT 
                    TO FIRST FISCAL YEAR OF PAYMENTS.

  ``(a) Non-Federal Contributions.--
          ``(1) In general.--The Secretary may not make payments under 
        section 1211(a) unless the State involved agrees, with respect 
        to the costs described in paragraph (2), to make available non-
        Federal contributions (in cash or in kind under subsection 
        (b)(1)) toward such costs in an amount that--
                  ``(A) for the second and third fiscal years of such 
                payments to the State, is not less than $1 for each $1 
                of Federal funds provided in such payments for such 
                fiscal years; and
                  ``(B) for the fourth and subsequent fiscal years of 
                such payments to the State, is not less than $2 for 
                each $1 of Federal funds provided in such payments for 
                such fiscal years.
          ``(2) Program costs.--The costs referred to in paragraph (1) 
        are--
                  ``(A) the costs to be incurred by the State in 
                carrying out the purpose described in section 1211(b); 
                or
                  ``(B) the costs of improving the quality and 
                availability of emergency medical services in rural 
                areas of the State.
          ``(3) Initial year of payments.--The Secretary may not 
        require a State to make non-Federal contributions as a 
        condition of receiving payments under section 1211(a) for the 
        first fiscal year of such payments to the State.
  ``(b) Determination of Amount of Non-Federal Contribution.--With 
respect to compliance with subsection (a) as a condition of receiving 
payments under section 1211(a)--
          ``(1) a State may make the non-Federal contributions required 
        in such subsection in cash or in kind, fairly evaluated, 
        including plant, equipment, or services; and
          ``(2) the Secretary may not, in making a determination of the 
        amount of non-Federal contributions, include amounts provided 
        by the Federal Government or services assisted or subsidized to 
        any significant extent by the Federal Government.''.

SEC. 7. REQUIREMENTS WITH RESPECT TO CARRYING OUT PURPOSE OF 
                    ALLOTMENTS.

  Section 1213 of the Public Health Service Act (42 U.S.C. 300d-13) is 
amended to read as follows:

``SEC. 1213. REQUIREMENTS WITH RESPECT TO CARRYING OUT PURPOSE OF 
                    ALLOTMENTS.

  ``(a) Trauma Care Modifications to State Plan for Emergency Medical 
Services.--With respect to the trauma care component of a State plan 
for the provision of emergency medical services, the modifications 
referred to in section 1211(b) are such modifications to the State plan 
as may be necessary for the State involved to ensure that the plan 
provides for access to the highest possible quality of trauma care, and 
that the plan--
          ``(1) specifies that the modifications required pursuant to 
        paragraphs (2) through (11) will be implemented by the 
        principal State agency with respect to emergency medical 
        services or by the designee of such agency;
          ``(2) specifies a public or private entity that will 
        designate trauma care regions and trauma centers in the State;
          ``(3) subject to subsection (b), contains national standards 
        and requirements of the American College of Surgeons or another 
        appropriate entity for the designation of level I and level II 
        trauma centers, and in the case of rural areas level III trauma 
        centers (including trauma centers with specified capabilities 
        and expertise in the care of pediatric trauma patients), by 
        such entity, including standards and requirements for--
                  ``(A) the number and types of trauma patients for 
                whom such centers must provide care in order to ensure 
                that such centers will have sufficient experience and 
                expertise to be able to provide quality care for 
                victims of injury;
                  ``(B) the resources and equipment needed by such 
                centers; and
                  ``(C) the availability of rehabilitation services for 
                trauma patients;
          ``(4) contains standards and requirements for the 
        implementation of regional trauma care systems, including 
        standards and guidelines (consistent with the provisions of 
        section 1867 of the Social Security Act) for medically directed 
        triage and transportation of trauma patients (including 
        patients injured in rural areas) prior to care in designated 
        trauma centers;
          ``(5) subject to subsection (b), contains national standards 
        and requirements, including those of the American Academy of 
        Pediatrics and the American College of Emergency Physicians, 
        for medically directed triage and transport of severely injured 
        children to designated trauma centers with specified 
        capabilities and expertise in the care of pediatric trauma 
        patients;
          ``(6) utilizes a program with procedures for the evaluation 
        of designated trauma centers (including trauma centers 
        described in paragraph (5)) and trauma care systems;
          ``(7) provides for the establishment and collection of data 
        in accordance with data collection requirements developed in 
        consultation with surgical, medical, and nursing specialty 
        groups, State and local emergency medical services directors, 
        and other trained professionals in trauma care, from each 
        designated trauma center in the State of a central data 
        reporting and analysis system--
                  ``(A) to identify the number of severely injured 
                trauma patients and the number of deaths from trauma 
                within trauma care systems in the State;
                  ``(B) to identify the cause of the injury and any 
                factors contributing to the injury;
                  ``(C) to identify the nature and severity of the 
                injury;
                  ``(D) to monitor trauma patient care (including 
                prehospital care) in each designated trauma center 
                within regional trauma care systems in the State 
                (including relevant emergency-department discharges and 
                rehabilitation information) for the purpose of 
                evaluating the diagnosis, treatment, and treatment 
                outcome of such trauma patients;
                  ``(E) to identify the total amount of uncompensated 
                trauma care expenditures for each fiscal year by each 
                designated trauma center in the State; and
                  ``(F) to identify patients transferred within a 
                regional trauma system, including reasons for such 
                transfer and the outcomes of such patients;
          ``(8) provides for the use of procedures by paramedics and 
        emergency medical technicians to assess the severity of the 
        injuries incurred by trauma patients;
          ``(9) provides for appropriate transportation and transfer 
        policies to ensure the delivery of patients to designated 
        trauma centers and other facilities within and outside of the 
        jurisdiction of such system, including policies to ensure that 
        only individuals appropriately identified as trauma patients 
        are transferred to designated trauma centers, and to provide 
        periodic reviews of the transfers and the auditing of such 
        transfers that are determined to be appropriate;
          ``(10) conducts public education activities concerning injury 
        prevention and obtaining access to trauma care;
          ``(11) coordinates planning for trauma systems with State 
        disaster emergency planning and bioterrorism hospital 
        preparedness planning; and
          ``(12) with respect to the requirements established in this 
        subsection, provides for coordination and cooperation between 
        the State and any other State with which the State shares any 
        standard metropolitan statistical area.
  ``(b) Certain Standards With Respect to Trauma Care Centers and 
Systems.--
          ``(1) In general.--The Secretary may not make payments under 
        section 1211(a) for a fiscal year unless the State involved 
        agrees that, in carrying out paragraphs (3) through (5) of 
        subsection (a), the State will adopt standards for the 
        designation of trauma centers, and for triage, transfer, and 
        transportation policies, and that the State will, in adopting 
        such standards--
                  ``(A) take into account national standards that 
                outline resources for optimal care of injured patients;
                  ``(B) consult with medical, surgical, and nursing 
                speciality groups, hospital associations, emergency 
                medical services State and local directors, concerned 
                advocates, and other interested parties;
                  ``(C) conduct hearings on the proposed standards 
                after providing adequate notice to the public 
                concerning such hearing; and
                  ``(D) beginning in fiscal year 2008, take into 
                account the model plan described in subsection (c).
          ``(2) Quality of trauma care.--The highest quality of trauma 
        care shall be the primary goal of State standards adopted under 
        this subsection.
          ``(3) Approval by the secretary.--The Secretary may not make 
        payments under section 1211(a) to a State if the Secretary 
        determines that--
                  ``(A) in the case of payments for fiscal year 2008 
                and subsequent fiscal years, the State has not taken 
                into account national standards, including those of the 
                American College of Surgeons, the American College of 
                Emergency Physicians, and the American Academy of 
                Pediatrics, in adopting standards under this 
                subsection; or
                  ``(B) in the case of payments for fiscal year 2008 
                and subsequent fiscal years, the State has not, in 
                adopting such standards, taken into account the model 
                plan developed under subsection (c).
  ``(c) Model Trauma Care Plan.--
          ``(1) In general.--Not later than 1 year after the date of 
        the enactment of the Trauma Care Systems Planning and 
        Development Act of 2007, the Secretary shall update the model 
        plan for the designation of trauma centers and for triage, 
        transfer, and transportation policies that may be adopted for 
        guidance by the State. Such plan shall--
                  ``(A) take into account national standards, including 
                those of the American College of Surgeons, American 
                College of Emergency Physicians, and the American 
                Academy of Pediatrics;
                  ``(B) take into account existing State plans;
                  ``(C) be developed in consultation with medical, 
                surgical, and nursing speciality groups, hospital 
                associations, emergency medical services State 
                directors and associations, and other interested 
                parties; and
                  ``(D) include standards for the designation of rural 
                health facilities and hospitals best able to receive, 
                stabilize, and transfer trauma patients to the nearest 
                appropriate designated trauma center, and for triage, 
                transfer, and transportation policies as they relate to 
                rural areas.
          ``(2) Applicability.--Standards described in paragraph (1)(D) 
        shall be applicable to all rural areas in the State, including 
        both non-metropolitan areas and frontier areas that have 
        populations of less than 6,000 per square mile.
  ``(d) Rule of Construction With Respect to Number of Designated 
Trauma Centers.--With respect to compliance with subsection (a) as a 
condition of the receipt of a grant under section 1211(a), such 
subsection may not be construed to specify the number of trauma care 
centers designated pursuant to such subsection.''.

SEC. 8. REQUIREMENT OF SUBMISSION TO SECRETARY OF TRAUMA PLAN AND 
                    CERTAIN INFORMATION.

  Section 1214 of the Public Health Service Act (42 U.S.C. 300d-14) is 
amended to read as follows:

``SEC. 1214. REQUIREMENT OF SUBMISSION TO SECRETARY OF TRAUMA PLAN AND 
                    CERTAIN INFORMATION.

  ``(a) In General.--For each fiscal year, the Secretary may not make 
payments to a State under section 1211(a) unless, subject to subsection 
(b), the State submits to the Secretary the trauma care component of 
the State plan for the provision of emergency medical services, 
including any changes to the trauma care component and any plans to 
address deficiencies in the trauma care component.
  ``(b) Interim Plan or Description of Efforts.--For each fiscal year, 
if a State has not completed the trauma care component of the State 
plan described in subsection (a), the State may provide, in lieu of 
such completed component, an interim component or a description of 
efforts made toward the completion of the component.
  ``(c) Information Received by State Reporting and Analysis System.--
The Secretary may not make payments to a State under section 1211(a) 
unless the State agrees that the State will, not less than once each 
year, provide to the Secretary the information received by the State 
pursuant to section 1213(a)(7).
  ``(d) Availability of Emergency Medical Services in Rural Areas.--The 
Secretary may not make payments to a State under section 1211(a) 
unless--
          ``(1) the State identifies any rural area in the State for 
        which--
                  ``(A) there is no system of access to emergency 
                medical services through the telephone number 911;
                  ``(B) there is no basic life-support system; or
                  ``(C) there is no advanced life-support system; and
          ``(2) the State submits to the Secretary a list of rural 
        areas identified pursuant to paragraph (1) or, if there are no 
        such areas, a statement that there are no such areas.''.

SEC. 9. RESTRICTIONS ON USE OF PAYMENTS.

  Section 1215 of the Public Health Service Act (42 U.S.C. 300d-15) is 
amended to read as follows:

``SEC. 1215. RESTRICTIONS ON USE OF PAYMENTS.

  ``(a) In General.--The Secretary may not, except as provided in 
subsection (b), make payments under section 1211(a) for a fiscal year 
unless the State involved agrees that the payments will not be 
expended--
          ``(1) for any purpose other than developing, implementing, 
        and monitoring the modifications required by section 1211(b) to 
        be made to the State plan for the provision of emergency 
        medical services;
          ``(2) to make cash payments to intended recipients of 
        services provided pursuant to this section;
          ``(3) to purchase or improve real property (other than minor 
        remodeling of existing improvements to real property);
          ``(4) to satisfy any requirement for the expenditure of non-
        Federal funds as a condition for the receipt of Federal funds; 
        or
          ``(5) to provide financial assistance to any entity other 
        than a public or nonprofit private entity.
  ``(b) Waiver.--The Secretary may waive a restriction under subsection 
(a) only if the Secretary determines that the activities outlined by 
the State plan submitted under section 1214(a) by the State involved 
cannot otherwise be carried out.''.

SEC. 10. REQUIREMENTS OF REPORTS BY STATES.

  The Public Health Service Act (42 U.S.C. 201 et seq.) is amended by 
striking section 1216.

SEC. 11. REPORT BY SECRETARY.

  Section 1222 of the Public Health Service Act (42 U.S.C. 300d-22) is 
amended to read as follows:

``SEC. 1222. REPORT BY SECRETARY.

  ``Not later than October 1, 2008, the Secretary shall report to the 
appropriate committees of Congress on the activities of the States 
carried out pursuant to section 1211. Such report shall include an 
assessment of the extent to which Federal and State efforts to develop 
systems of trauma care and to designate trauma centers have reduced the 
incidence of mortality, and the incidence of permanent disability, 
resulting from trauma. Such report may include any recommendations of 
the Secretary for appropriate administrative and legislative 
initiatives with respect to trauma care.''.

SEC. 12. FUNDING.

  Section 1232 of the Public Health Service Act (42 U.S.C. 300d-32) is 
amended to read as follows:

``SEC. 1232. FUNDING.

  ``(a) Authorization of Appropriations.--For the purpose of carrying 
out parts A and B, subject to subsections (b) and (c), there are 
authorized to be appropriated $12,000,000 for fiscal year 2008, 
$10,000,000 for fiscal year 2009, and $8,000,000 for each of the fiscal 
years 2010 through 2012.
  ``(b) Reservation of Funds.--If the amount appropriated under 
subsection (a) for a fiscal year is equal to or less than $1,000,000, 
such appropriation is available only for the purpose of carrying out 
part A. If the amount so appropriated is greater than $1,000,000, 50 
percent of such appropriation shall be made available for the purpose 
of carrying out part A and 50 percent shall be made available for the 
purpose of carrying out part B.
  ``(c) Allocation of Part A Funds.--Of the amounts appropriated under 
subsection (a) for a fiscal year to carry out part A--
          ``(1) 10 percent of such amounts for such year shall be 
        allocated for administrative purposes; and
          ``(2) 10 percent of such amounts for such year shall be 
        allocated for the purpose of carrying out section 1202.''.

SEC. 13. RESIDENCY TRAINING PROGRAMS IN EMERGENCY MEDICINE.

  Section 1251 of the Public Health Service Act (42 U.S.C. 300d-51) is 
amended to read as follows:

``SEC. 1251. RESIDENCY TRAINING PROGRAMS IN EMERGENCY MEDICINE.

  ``(a) In General.--The Secretary may make grants to public and 
nonprofit private entities for the purpose of planning and developing 
approved residency training programs in emergency medicine.
  ``(b) Identification and Referral of Domestic Violence.--The 
Secretary may make a grant under subsection (a) only if the applicant 
involved agrees that the training programs under subsection (a) will 
provide education and training in identifying and referring cases of 
domestic violence.
  ``(c) Authorization of Appropriations.--For the purpose of carrying 
out this section, there is authorized to be appropriated $400,000 for 
each of the fiscal years 2008 though 2012.''.

SEC. 14. STATE GRANTS FOR CERTAIN PROJECTS.

  Section 1252 of the Public Health Service Act (42 U.S.C. 300d-52) is 
amended in the section heading by striking ``DEMONSTRATION''.

                          Purpose and Summary

    The purpose of H.R. 727, the Trauma Care Systems Planning 
and Development Act of 2007, is to amend the Public Health 
Service Act to add requirements regarding trauma care, and for 
other purposes. The legislation would reauthorize title XII of 
the Public Health Service Act for a period of 5 years to 
establish formula and competitive grants for the purpose of 
planning, implementing, and developing statewide trauma care 
systems.

                  Background and Need for Legislation

    Traumatic injury is one of the most important public health 
problems facing the United States. Each year more than 150,000 
Americans die from traumatic injuries, another two million 
people are seriously injured. Trauma and injury are leading 
causes of death and disability of Americans between the ages of 
1 and 44 years, the third leading cause of death in the general 
population of the United States. Most traumatic injury is due 
to motor vehicle collisions, violence, and falls.
    A trauma care system is an organized approach to 
facilitating and coordinating a response to traumatic injury 
for severely injured patients. This multidisciplinary approach 
includes injury prevention, emergency transport, emergency 
department care, surgical intervention, hospital care, 
rehabilitative services and social services that enable the 
patient to return to society at the most productive level. 
Adequate and timely trauma care is life sustaining for the 
severely injured patients.
    Both death and disability for severely injured patients are 
reduced drastically when definitive, timely trauma care is 
provided. Inadequate systems of trauma care at both the 
community and hospital levels, as well as inequities in access 
to prehospital and hospital emergency services contribute to 
high rates of death and disability, particularly in rural and 
medically underserved areas. According to a 2004 study of the 
National Center for Injury Prevention and Control at the 
Centers for Disease Control and Prevention, as many as 35 
percent of trauma patients' deaths could have been prevented if 
optimal acute care had been available.
    Trauma care systems are vital to our Nation's public health 
and emergency preparedness infrastructure. Strengthening title 
XII programs governing trauma care system planning and 
development will help to enhance disaster preparedness and 
reduce death and disability for those experiencing traumatic 
injury.

                                Hearings

    The Committee on Energy and Commerce has not held hearings 
on the legislation.

                        Committee Consideration

    On Tuesday, March 13, 2007, the Subcommittee on Health met 
in open markup session and approved H.R. 727 for full Committee 
consideration, amended, by voice vote. On Thursday, March 15, 
2007, the full Committee met in open markup session and ordered 
H.R. 727 favorably reported to the House, as amended, by voice 
vote.

                            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. 727 reported. A motion by Mr. Dingell to 
order H.R. 727 favorably reported to the House, amended, was 
agreed to by voice vote.

                      Committee Oversight Findings

    Regarding clause 3(c)(1) of rule XIII of the Rules of the 
House of Representatives, the Committee has not held oversight 
or legislative hearings on this legislation.

         Statement of General Performance Goals and Objectives

    The goals and objectives of H.R. 727 are to improve 
emergency medical services to ensure that severely injured 
patients receive prompt trauma care, thereby reducing the rates 
of lifelong traumatic injuries and death. Particular emphasis 
is placed on improving trauma care systems in rural areas, 
which disproportionately experience challenges in communication 
and coordination with State trauma 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. 727 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. 727 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 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 
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, March 19, 2007.
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. 727, the Trauma 
Care Systems Planning and Development Act of 2007.
    If you wish further details on this estimate, we will be 
pleased to provide them. The CBO staff contact is Camile 
Williams.
            Sincerely,
                                           Peter R. Orszag,
                                                          Director.
    Enclosure.

H.R. 727--Trauma Care Systems Planning and Development Act of 2007

    Summary: H.R. 727 would amend the Public Health Service Act 
to authorize several emergency services and trauma care 
programs administered by the Health Resources and Services 
Administration (HRSA). The trauma care programs include grants 
and cooperative agreements to assist states in the improvement 
and development of trauma care systems and emergency care 
residency training programs.
    Assuming that the specified amounts are appropriated for 
fiscal years 2008 through 2012, CBO estimates that implementing 
H.R. 727 would cost $40 million over the 2008-2012 period. The 
legislation would not affect direct spending or receipts.
    H.R. 727 contains no intergovernmental or private-sector 
mandates as defined in the Unfunded Mandates Reform Act (UMRA) 
and would benefit states. The bill would authorize grant 
programs designed to improve the quality of trauma care 
systems. States that choose to apply for those grants would 
have to provide matching funds, but any costs they face would 
be incurred voluntarily.
    Estimated cost to the Federal Government: The estimated 
budgetary impact of H.R. 727 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
----------------------------------------------------------------------------------------------------------------
                                  CHANGES IN SPENDING SUBJECT TO APPROPRIATION

Authorization Level................................................       12       10        8        8        8
Estimated Outlays..................................................        5       10        9        8        8
----------------------------------------------------------------------------------------------------------------

    Basis of estimate: H.R. 727 would authorize the 
appropriation of $12 million in fiscal year 2008, $10 million 
in 2009, and $8 million in each of fiscal years 2010 through 
2012 for trauma-related grant programs. The bill also would 
authorize the appropriation of $400,000 a year for grants to 
plan and develop residency programs in emergency medicine. 
Based on spending patterns for similar grant programs (which 
were funded through 2006, and assuming authorization of 
specified amounts, CBO estimates that implementing H.R. 727 
would cost $5 million in 2008 and $40 million over the 2008-
2012 period.
    The bill would authorize HRSA to make grants to states for 
the planning, development, and improvement of trauma care 
centers and systems. H.R. 727 also would authorize HRSA to make 
grants to public and private nonprofit entities to improve 
access to trauma care and to conduct research and demonstration 
projects to improve the availability and quality of emergency 
medical services in rural areas.
    The planning grant part of the program provides federal 
matching payments to funds spent by states. The federal 
government would provide $1 for every $1 of state spending in 
the second and third year and $1 for every $2 of state spending 
in the fourth and subsequent years. The grants to public or 
provide nonprofit agencies would not require matching payment 
by those agencies. CBO estimates that implementing the grant 
program would cost $5 million in 2008 and $38 million over the 
2008-2012 period, assuming the appropriation of the specified 
amounts.
    The grants for residency training programs in emergency 
medicine would provide funding to public and private nonprofit 
entities to develop residency program with an emphasis on 
treatment and referral of domestic violence cases. CBO 
estimates that implementing this provision would cost $2 
million over the 2008-2012 period.
    Intergovernmental and private-sector impact: The bill 
contains no intergovernmental or private-sector mandates as 
defined in UMRA and would impose on costs on state, local, or 
tribal governments. The bill would authorize grant programs 
designed to improve the quality of trauma care systems. States 
that choose to apply for those grants would have to provide 
matching funds, but any costs they face would be incurred 
voluntarily.
    Estimate prepared by: Federal Costs: Camile Williams. 
Impact on State, Local, and Tribal Governments: Leo Lex. Impact 
on the Private Sector: Paige Shevlin.
    Estimate approved by: Peter H. Fontaine, Deputy Assistant 
Director for Budget Analysis.

                       Federal Mandates Statement

    The Committee adopts as its own the estimate of Federal 
mandates 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 were created by this 
legislation.

                   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 this legislation 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 the legislation 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.

             Section-by-Section Analysis of the Legislation


Section 1. Short title

    Section 1 establishes the short title as the ``Trauma Care 
Systems Planning and Development Act of 2007.''

Section 2. Establishment

    Section 2 amends the Public Health Service Act to direct 
the Secretary of Health and Human Services, either directly or 
through cooperative agreement and contract, to promote and 
enhance a State's capacity with respect to trauma care through 
information sharing, technical assistance, data collection, and 
workshops and conferences.

Section 3. Clearinghouse on Trauma Care and Emergency Medical Services

    Section 3 strikes the section that relates to the National 
Clearinghouse on Trauma Care and Emergency Medical Services.

Section 4. Establishment of programs for improving trauma care in rural 
        areas

    Section 4 allows the Secretary to make grants to entities 
to carry out demonstration projects to improve emergency 
medical services in rural areas by increasing communication and 
coordination with state trauma systems.

Section 5. Competitive grants

    Section 5 allows the Secretary, acting through the 
Administrator of the Health Resources and Services 
Administration, to make grants to States, political 
subdivisions, or consortia of States or political subdivisions 
to improve access to and enhance the development of trauma care 
system.

Section 6. Requirements of matching funds for fiscal years subsequent 
        to first fiscal year of payments

    Section 6 revises the matching requirements for States to 
be eligible for grants so that a State increases its share of 
non-Federal contribution (in cash and in kind), in subsequent 
fiscal years.

Section 7. Requirements with respect to carrying out purpose of 
        allotments

    Section 7 revises the requirement of trauma care 
modifications to the State plan to ensure that the plan 
provides for access to the highest possible quality of trauma 
care.
    The section prohibits the Secretary from making trauma care 
grants to a State unless the State's emergency medical services 
plan coordinates planning for trauma systems with state 
disaster emergency planning and bioterrorism hospital 
preparedness planning.
    The section directs the Secretary to update the model 
trauma care plan to update policies that may be adopted by the 
State.

Section 8. Requirement of submission to Secretary of trauma plan and 
        certain information

    Section 8 prohibits the Secretary from making trauma care 
grants to a State unless the State submits to the Secretary the 
trauma care component of the State plan, including any changes 
to the trauma care component together with any deficiencies, an 
interim component, or description of effort toward the 
completion of the component. States must evaluate the 
availability of emergency medical services in rural areas.
    The section directs the Secretary to update the model plan 
for the designation of trauma centers and for triage, transfer, 
and transportation policies.

Section 9. Restrictions on use of payments

    Section 9 revises the restrictions on use of payments and 
modifies the waiver authority of the Secretary over such 
restrictions.

Section 10. Requirements of reports by States

    Section 10 strikes section 1216, which requires annual 
reports by States.

Section 11. Report by Secretary

    Section 11 requires the Secretary to report to Congress on 
Federal and State efforts to develop systems of trauma care no 
later than October 1, 2008.

Section 12. Funding

    Section 12 extends the authorization of appropriations for 
parts A and B for five fiscal years through fiscal year 2012. 
The section clarifies that the amount authorized to be 
appropriated for carrying out part A (program and competitive 
grant funding) and part B (State formula funding) is for the 
purposes of carrying out each part, which may include 
administrative and technical assistance. Clarifies that under 
part A, 10 percent is allocated to each for administrative 
purposes and 10 percent is allocated for the purpose of 
carrying out rural trauma improvement under section 1202.

Section 13. Residency training programs in emergency medicine

    Section 13 extends the authorization of appropriations for 
section 1251 for five fiscal years through fiscal year 2012.

Section 14. State grants for certain projects

    Section 14 amends the section heading of section 1252 so 
that it reads ``State Grants for Projects Regarding 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 XII--TRAUMA CARE

           Part A--General Authority and Duties of Secretary

[SEC. 1201. ESTABLISHMENT.

  [(a) In General.--The Secretary shall, with respect to trauma 
care--
          [(1) conduct and support research, training, 
        evaluations, and demonstration projects;
          [(2) foster the development of appropriate, modern 
        systems of such care through the sharing of information 
        among agencies and individuals involved in the study 
        and provision of such care;
          [(3) provide to State and local agencies technical 
        assistance; and
          [(4) sponsor workshops and conferences.
  [(b) Grants, Cooperative Agreements, and Contracts.--The 
Secretary may make grants, and enter into cooperative 
agreements and contracts, for the purpose of carrying out 
subsection (a).
  [(c) Administration.--The Administrator of the Health 
Resources and Services Administration shall ensure that this 
title is administered by the Division of Trauma and Emergency 
Medical Systems within such Administration. Such Division shall 
be headed by a director appointed by the Secretary from among 
individuals who are knowledgeable by training or experience in 
the development and operation of trauma and emergency medical 
systems.

[SEC. 1202. CLEARINGHOUSE ON TRAUMA CARE AND EMERGENCY MEDICAL 
                    SERVICES.

  [(a) Establishment.--The Secretary shall by contract provide 
for the establishment and operation of a National Clearinghouse 
on Trauma Care and Emergency Medical Services (hereafter in 
this section referred to as the ``Clearinghouse'').
  [(b) Duties.--The Clearinghouse shall--
          [(1) foster the development of appropriate, modern 
        trauma care and emergency medical services (including 
        the development of policies for the notification of 
        family members of individuals involved in medical 
        emergencies) through the sharing of information among 
        agencies and individuals involved in planning, 
        furnishing, and studying such services and care;
          [(2) collect, compile, and disseminate information on 
        the achievements of, and problems experienced by, State 
        and local agencies and private entities in providing 
        trauma care and emergency medical services and, in so 
        doing, give special consideration of the unique needs 
        of rural areas;
          [(3) provide technical assistance relating to trauma 
        care and emergency medical services to State and local 
        agencies; and
          [(4) sponsor workshops and conferences on trauma care 
        and emergency medical services.
  [(c) Fees and Assessments.--A contract entered into by the 
Secretary under this section may provide that the Clearinghouse 
charge fees or assessments in order to defray, and beginning 
with fiscal year 1992, to cover, the costs of operating the 
Clearinghouse.

[SEC. 1203. ESTABLISHMENT OF PROGRAMS FOR IMPROVING TRAUMA CARE IN 
                    RURAL AREAS.

  [(a) In General.--The Secretary may make grants to public and 
nonprofit private entities for the purpose of carrying out 
research and demonstration projects with respect to improving 
the availability and quality of emergency medical services in 
rural areas--
          [(1) by developing innovative uses of communications 
        technologies and the use of new communications 
        technology;
          [(2) by developing model curricula for training 
        emergency medical services personnel, including first 
        responders, emergency medical technicians, emergency 
        nurses and physicians, and paramedics--
                  [(A) in the assessment, stabilization, 
                treatment, preparation for transport, and 
                resuscitation of seriously injured patients, 
                with special attention to problems that arise 
                during long transports and to methods of 
                minimizing delays in transport to the 
                appropriate facility; and
                  [(B) in the management of the operation of 
                the emergency medical services system;
          [(3) by making training for original certification, 
        and continuing education, in the provision and 
        management of emergency medical services more 
        accessible to emergency medical personnel in rural 
        areas through telecommunications, home studies, 
        providing teachers and training at locations accessible 
        to such personnel, and other methods;
          [(4) by developing innovative protocols and 
        agreements to increase access to prehospital care and 
        equipment necessary for the transportation of seriously 
        injured patients to the appropriate facilities; and
          [(5) by evaluating the effectiveness of protocols 
        with respect to emergency medical services and systems.
  [(b) Special Consideration for Certain Rural Areas.--In 
making grants under subsection (a), the Secretary shall give 
special consideration to any applicant for the grant that will 
provide services under the grant in any rural area identified 
by a State under section 1214(c)(1).
  [(c) Requirement of Application.--The Secretary may not make 
a grant under subsection (a) unless an application for the 
grant is submitted to the Secretary and the application is in 
such form, is made in such manner, and contains such 
agreements, assurances, and information as the Secretary 
determines to be necessary to carry out this section.]

SEC. 1201. ESTABLISHMENT.

  (a) In General.--The Secretary shall, with respect to trauma 
care--
          (1) conduct and support research, training, 
        evaluations, and demonstration projects;
          (2) foster the development of appropriate, modern 
        systems of such care through the sharing of information 
        among agencies and individuals involved in the study 
        and provision of such care;
          (3) collect, compile, and disseminate information on 
        the achievements of, and problems experienced by, State 
        and local agencies and private entities in providing 
        trauma care and emergency medical services and, in so 
        doing, give special consideration to the unique needs 
        of rural areas;
          (4) provide to State and local agencies technical 
        assistance to enhance each State's capability to 
        develop, implement, and sustain the trauma care 
        component of each State's plan for the provision of 
        emergency medical services;
          (5) sponsor workshops and conferences; and
          (6) promote the collection and categorization of 
        trauma data in a consistent and standardized manner.
  (b) Grants, Cooperative Agreements, and Contracts.--The 
Secretary may make grants, and enter into cooperative 
agreements and contracts, for the purpose of carrying out 
subsection (a).

SEC. 1202. ESTABLISHMENT OF PROGRAMS FOR IMPROVING TRAUMA CARE IN RURAL 
                    AREAS.

  (a) In General.--The Secretary may make grants to public and 
nonprofit private entities for the purpose of carrying out 
research and demonstration projects with respect to improving 
the availability and quality of emergency medical services in 
rural areas--
          (1) by developing innovative uses of communications 
        technologies and the use of new communications 
        technology;
          (2) by developing model curricula, such as advanced 
        trauma life support, for training emergency medical 
        services personnel, including first responders, 
        emergency medical technicians, emergency nurses and 
        physicians, and paramedics--
                  (A) in the assessment, stabilization, 
                treatment, preparation for transport, and 
                resuscitation of seriously injured patients, 
                with special attention to problems that arise 
                during long transports and to methods of 
                minimizing delays in transport to the 
                appropriate facility; and
                  (B) in the management of the operation of the 
                emergency medical services system;
          (3) by making training for original certification, 
        and continuing education, in the provision and 
        management of emergency medical services more 
        accessible to emergency medical personnel in rural 
        areas through telecommunications, home studies, 
        providing teachers and training at locations accessible 
        to such personnel, and other methods;
          (4) by developing innovative protocols and agreements 
        to increase access to prehospital care and equipment 
        necessary for the transportation of seriously injured 
        patients to the appropriate facilities;
          (5) by evaluating the effectiveness of protocols with 
        respect to emergency medical services and systems; and
          (6) by increasing communication and coordination with 
        State trauma systems.
  (b) Special Consideration for Certain Rural Areas.--In making 
grants under subsection (a), the Secretary shall give special 
consideration to any applicant for the grant that will provide 
services under the grant in any rural area identified by a 
State under section 1214(d)(1).
  (c) Requirement of Application.--The Secretary may not make a 
grant under subsection (a) unless an application for the grant 
is submitted to the Secretary and the application is in such 
form, is made in such manner, and contains such agreements, 
assurances, and information as the Secretary determines to be 
necessary to carry out this section.

SEC. 1203. COMPETITIVE GRANTS FOR THE IMPROVEMENT OF TRAUMA CARE.

  (a) In General.--The Secretary, acting through the 
Administrator of the Health Resources and Services 
Administration, may make grants to States, political 
subdivisions, or consortia of States or political subdivisions 
for the purpose of improving access to and enhancing the 
development of trauma care systems.
  (b) Use of Funds.--The Secretary may make a grant under this 
section only if the applicant agrees to use the grant--
          (1) to integrate and broaden the reach of a trauma 
        care system, such as by developing innovative protocols 
        to increase access to prehospital care;
          (2) to strengthen, develop, and improve an existing 
        trauma care system;
          (3) to expand communications between the trauma care 
        system and emergency medical services through improved 
        equipment or a telemedicine system;
          (4) to improve data collection and retention; or
          (5) to increase education, training, and technical 
        assistance opportunities, such as training and 
        continuing education in the management of emergency 
        medical services accessible to emergency medical 
        personnel in rural areas through telehealth, home 
        studies, and other methods.
  (c) Preference.--In selecting among States, political 
subdivisions, and consortia of States or political subdivisions 
for purposes of making grants under this section, the Secretary 
shall give preference to applicants that--
          (1) have developed a process, using national 
        standards, for designating trauma centers;
          (2) recognize protocols for the delivery of seriously 
        injured patients to trauma centers;
          (3) implement a process for evaluating the 
        performance of the trauma system; and
          (4) agree to participate in information systems 
        described in section 1202 by collecting, providing, and 
        sharing information.
  (d) Priority.--In making grants under this section, the 
Secretary shall give priority to applicants that will use the 
grants to focus on improving access to trauma care systems.
  (e) Special Consideration.--In awarding grants under this 
section, the Secretary shall give special consideration to 
projects that demonstrate strong State or local support, 
including availability of non-Federal contributions.

Part B--Formula Grants With Respect to Modifications of State Plans

           *       *       *       *       *       *       *


[SEC. 1212 REQUIREMENT OF MATCHING FUNDS FOR FISCAL YEARS SUBSEQUENT TO 
                    FIRST FISCAL YEAR OF PAYMENTS.

  [(a) Non-Federal Contributions.--
          [(1) In general.--The Secretary may not make payments 
        under section 1211(a) unless the State involved agrees, 
        with respect to the costs described in paragraph (2), 
        to make available non-Federal contributions (in cash or 
        in kind under subsection (b)(1)) toward such costs in 
        an amount equal to--
                  [(A) for the second fiscal year of such 
                payments to the State, not less than $1 for 
                each $1 of Federal funds provided in such 
                payments for such fiscal year; and
                  [(B) for any subsequent fiscal year of such 
                payments to the State, not less than $3 for 
                each $1 of Federal funds provided in such 
                payments for such fiscal year.
          [(2) Program costs.--The costs referred to in 
        paragraph (1) are--
                  [(A) the costs to be incurred by the State in 
                carrying out the purpose described in section 
                1211(b); or
                  [(B) the costs of improving the quality and 
                availability of emergency medical services in 
                rural areas of the State.
          [(3) Initial year of payments.--The Secretary may not 
        require a State to make non-Federal contributions as a 
        condition of receiving payments under section 1211(a) 
        for the first fiscal year of such payments to the 
        State.
  [(b) Determination of Amount of Non-Federal Contribution.--
With respect to compliance with subsection (a) as a condition 
of receiving payments under section 1211(a)--
          [(1) a State may make the non-Federal contributions 
        required in such subsection in cash or in kind, fairly 
        evaluated, including plant, equipment, or services;
          [(2) the Secretary may not, in making a determination 
        of the amount of non-Federal contributions, include 
        amounts provided by the Federal Government or services 
        assisted or subsidized to any significant extent by the 
        Federal Government; and
          [(3) the Secretary shall, in making such a 
        determination, include only non-Federal contributions 
        in excess of the amount of non-Federal contributions 
        made by the State during fiscal year 1990 toward--
                  [(A) the costs of providing trauma care in 
                the State; and
                  [(B) the costs of improving the quality and 
                availability of emergency medical services in 
                rural areas of the State.

[SEC. 1213. REQUIREMENTS WITH RESPECT TO CARRYING OUT PURPOSE OF 
                    ALLOTMENTS.

  [(a) Trauma Care Modifications to State Plan for Emergency 
Medical Services.--With respect to the trauma care component of 
a State plan for the provision of emergency medical services, 
the modifications referred to in section 1211(b) are such 
modifications to the State plan as may be necessary for the 
State involved to ensure that the plan provides for access to 
the highest possible quality of trauma care, and that the 
plan--
          [(1) specifies that the modifications required 
        pursuant to paragraphs (2) through (10) will be 
        implemented by the principal State agency with respect 
        to emergency medical services or by the designee of 
        such agency;
          [(2) specifies any public or private entity that will 
        designate trauma care regions and trauma centers in the 
        State;
          [(3) subject to subsection (b), contains standards 
        and requirements for the designation of level I and 
        level II trauma centers, and in the case of rural areas 
        level III trauma centers (including trauma centers with 
        specified capabilities and expertise in the care of the 
        pediatric trauma patient), by such entity, including 
        standards and requirements for--
                  [(A) the number and types of trauma patients 
                for whom such centers must provide care in 
                order to ensure that such centers will have 
                sufficient experience and expertise to be able 
                to provide quality care for victims of injury;
                  [(B) the resources and equipment needed by 
                such centers; and
                  [(C) the availability of rehabilitation 
                services for trauma patients;
          [(4) subject to subsection (b), contains standards 
        and requirements for the implementation of regional 
        trauma care systems, including standards and guidelines 
        (consistent with the provisions of section 1867 of the 
        Social Security Act) for medically directed triage and 
        transportation of trauma patients (including patients 
        injured in rural areas) prior to care in designated 
        trauma centers;
          [(5) subject to subsection (b), contains standards 
        and requirements for medically directed triage and 
        transport of severely injured children to designated 
        trauma centers with specified capabilities and 
        expertise in the care of the pediatric trauma patient;
          [(6) specifies procedures for the evaluation of 
        designated trauma centers (including trauma centers 
        described in paragraph (5)) and trauma care systems;
          [(7) provides for the establishment and collection of 
        data from each designated trauma center in the State of 
        a central data reporting and analysis system--
                  [(A) to identify the number of severely 
                injured trauma patients within regional trauma 
                care systems in the State;
                  [(B) to identify the cause of the injury and 
                any factors contributing to the injury;
                  [(C) to identify the nature and severity of 
                the injury;
                  [(D) to monitor trauma patient care 
                (including prehospital care) in each designated 
                trauma center within regional trauma care 
                systems in the State (including relevant 
                emergency-department discharges and 
                rehabilitation information) for the purpose of 
                evaluating the diagnosis, treatment and 
                treatment outcome of such trauma patients;
                  [(E) to identify the total amount of 
                uncompensated trauma care expenditures for each 
                fiscal year by each designated trauma center in 
                the State; and
                  [(F) to identify patients transferred within 
                a regional trauma system, including reasons for 
                such transfer;
          [(8) provides for the use of procedures by paramedics 
        and emergency medical technicians to assess the 
        severity of the injuries incurred by trauma patients;
          [(9) provides for appropriate transportation and 
        transfer policies to ensure the delivery of patients to 
        designated trauma centers and other facilities within 
        and outside of the jurisdiction of such system, 
        including policies to ensure that only individuals 
        appropriately identified as trauma patients are 
        transferred to designated trauma centers, and to 
        provide periodic reviews of the transfers and the 
        auditing of such transfers that are determined to be 
        appropriate;
          [(10) conducts public education activities concerning 
        injury prevention and obtaining access to trauma care; 
        and
          [(11) with respect to the requirements established in 
        this subsection, provides for coordination and 
        cooperation between the State and any other State with 
        which the State shares any standard metropolitan 
        statistical area.
  [(b)  Certain Standards With Respect to Trauma Care Centers 
and Systems.--
          [(1) In general.--The Secretary may not make payments 
        under section 1211(a) for a fiscal year unless the 
        State involved agrees that, in carrying out paragraphs 
        (3) through (5) of subsection (a), the State will adopt 
        standards for the designation of trauma centers, and 
        for triage, transfer, and transportation policies, and 
        that the State will, in adopting such standards--
                  [(A) take into account national standards 
                concerning such;
                  [(B) consult with medical, surgical, and 
                nursing speciality groups, hospital 
                associations, emergency medical services State 
                and local directors, concerned advocates and 
                other interested parties;
                  [(C) conduct hearings on the proposed 
                standards after providing adequate notice to 
                the public concerning such hearing; and
                  [(D) beginning in fiscal year 1992, take into 
                account the model plan described in subsection 
                (c).
          [(2) Quality of trauma care.--The highest quality of 
        trauma care shall be the primary goal of State 
        standards adopted under this subsection.
          [(3) Approval by secretary.--The Secretary may not 
        make payments under section 1211(a) to a State if the 
        Secretary determines that--
                  [(A) in the case of payments for fiscal year 
                1991 and subsequent fiscal years, the State has 
                not taken into account national standards, 
                including those of the American College of 
                Surgeons, the American College of Emergency 
                Physicians and the American Academy of 
                Pediatrics, in adopting standards under this 
                subsection; or
                  [(B) in the case of payments for fiscal year 
                1992 and subsequent fiscal years, the State has 
                not, in adopting such standards, taken into 
                account the model plan developed under 
                subsection (c) .
  [(c) Model Trauma Care Plan.--Not later than 1 year after the 
date of the enactment of the Trauma Care Systems Planning and 
Development Act of 1990, the Secretary shall develop a model 
plan for the designation of trauma centers and for triage, 
transfer and transportation policies that may be adopted for 
guidance by the State. Such plan shall--
          [(1) take into account national standards, including 
        those of the American College of Surgeons, American 
        College of Emergency Physicians and the American 
        Academy of Pediatrics;
          [(2) take into account existing State plans;
          [(3) be developed in consultation with medical, 
        surgical, and nursing speciality groups, hospital 
        associations, emergency medical services State 
        directors and associations, and other interested 
        parties; and
          [(4) include standards for the designation of rural 
        health facilities and hospitals best able to receive, 
        stabilize, and transfer trauma patients to the nearest 
        appropriate designated trauma center, and for triage, 
        transfer, and transportation policies as they relate to 
        rural areas.
Standards described in paragraph (4) shall be applicable to all 
rural areas in the State, including both non-metropolitan areas 
and frontier areas that have populations of less than 6,000 per 
square mile.
  [(d) Rule of Construction With Respect to Number of 
Designated Trauma Centers.--With respect to compliance with 
subsection (a) as a condition of the receipt of a grant under 
section 1211(a), such subsection may not be construed to 
specify the number of trauma care centers designated pursuant 
to such subsection.

[SEC. 1214. REQUIREMENT OF SUBMISSION TO SECRETARY OF TRAUMA PLAN AND 
                    CERTAIN INFORMATION.

  [(a) Trauma Plan.--
          [(1) In general.--For fiscal year 1991 and subsequent 
        fiscal years, the Secretary may not make payments under 
        section 1211(a) unless, subject to paragraph (2), the 
        State involved submits to the Secretary the trauma care 
        component of the State plan for the provision of 
        emergency medical services.
          [(2) Interim plan or description of efforts.--For 
        fiscal year 1991, if a State has not completed the 
        trauma care component of the State plan described in 
        paragraph (1), the State may provide, in lieu of a 
        completed such component, an interim component or a 
        description of efforts made toward the completion of 
        the component.
  [(b) Information Received by State Reporting and Analysis 
System.--The Secretary may not make payments under section 
1211(a) for a fiscal year unless the State involved agrees that 
the State will, not less than once each year, provide to the 
Secretary the information received by the State pursuant to 
section 1213(a)(7).
  [(c) Availability of Emergency Medical Services in Rural 
Areas.--The Secretary may not make payments under section 
1211(a) for a fiscal year unless--
          [(1) the State involved identifies any rural area in 
        the State for which--
                  [(A) there is no system of access to 
                emergency medical services through the 
                telephone number 911;
                  [(B) there is no basic life-support system; 
                or
                  [(C) there is no advanced life-support 
                system; and
          [(2) the State submits to the Secretary a list of 
        rural areas identified pursuant to paragraph (1) or, if 
        there are no such areas, a statement that there are no 
        such areas.

[SEC. 1215. RESTRICTIONS ON USE OF PAYMENTS.

  [(a) In General.--The Secretary may not, except as provided 
in subsection (b), make payments under section 1211(a) for a 
fiscal year unless the State involved agrees that the payments 
will not be expended--
          [(1) subject to section 1233, for any purpose other 
        than developing, implementing, and monitoring the 
        modifications required by section 1211(b) to be made to 
        the State plan for the provision of emergency medical 
        services.
          [(2) to make cash payments to intended recipients of 
        services provided pursuant to such section;
          [(3) to purchase or improve real property (other than 
        minor remodeling of existing improvements to real 
        property) or to purchase major medical or communication 
        equipment, ambulances, or aircraft;
          [(4) to satisfy any requirement for the expenditure 
        of non-Federal funds as a condition for the receipt of 
        Federal funds; or
          [(5) to provide financial assistance to any entity 
        other than a public or nonprofit private entity.
  [(b) Exception.--If the Secretary finds that the purpose 
described in section 1211(b) cannot otherwise be carried out, 
the Secretary may, with respect to an otherwise qualified 
State, waive the restriction established in subsection (a)(3).

[SEC. 1216. REQUIREMENT OF REPORTS BY STATES.

  [(a) In General.--The Secretary may not make payments under 
section 1211(a) for a fiscal year unless the State involved 
agrees to prepare and submit to the Secretary an annual report 
in such form and containing such information as the Secretary 
determines (after consultation with the States) to be necessary 
for--
          [(1) securing a record and a description of the 
        purposes for which payments received by the State 
        pursuant to such section were expended and of the 
        recipients of such payments; and
          [(2) determining whether the payments were expended 
        in accordance with the purpose of the program involved.
  [(b) Availability to Public of Reports.--The Secretary may 
not make payments under section 1211(a) unless the State 
involved agrees that the State will make copies of the report 
described in subsection (a) available for public inspection.
  [(c) Evaluations by Comptroller General.--The Comptroller 
General of the United States shall evaluate the expenditures by 
States of payments under section 1211(a) in order to assure 
that expenditures are consistent with the provisions of this 
part, and not later than December 1, 1994, prepare and submit 
to the Committee on Energy and Commerce of the House of 
Representatives and the Committee on Labor and Human Resources 
of the Senate a report concerning such evaluation.]

SEC. 1212. REQUIREMENT OF MATCHING FUNDS FOR FISCAL YEARS SUBSEQUENT TO 
                    FIRST FISCAL YEAR OF PAYMENTS.

  (a) Non-Federal Contributions.--
          (1) In general.--The Secretary may not make payments 
        under section 1211(a) unless the State involved agrees, 
        with respect to the costs described in paragraph (2), 
        to make available non-Federal contributions (in cash or 
        in kind under subsection (b)(1)) toward such costs in 
        an amount that--
                  (A) for the second and third fiscal years of 
                such payments to the State, is not less than $1 
                for each $1 of Federal funds provided in such 
                payments for such fiscal years; and
                  (B) for the fourth and subsequent fiscal 
                years of such payments to the State, is not 
                less than $2 for each $1 of Federal funds 
                provided in such payments for such fiscal 
                years.
          (2) Program costs.--The costs referred to in 
        paragraph (1) are--
                  (A) the costs to be incurred by the State in 
                carrying out the purpose described in section 
                1211(b); or
                  (B) the costs of improving the quality and 
                availability of emergency medical services in 
                rural areas of the State.
          (3) Initial year of payments.--The Secretary may not 
        require a State to make non-Federal contributions as a 
        condition of receiving payments under section 1211(a) 
        for the first fiscal year of such payments to the 
        State.
  (b) Determination of Amount of Non-Federal Contribution.--
With respect to compliance with subsection (a) as a condition 
of receiving payments under section 1211(a)--
          (1) a State may make the non-Federal contributions 
        required in such subsection in cash or in kind, fairly 
        evaluated, including plant, equipment, or services; and
          (2) the Secretary may not, in making a determination 
        of the amount of non-Federal contributions, include 
        amounts provided by the Federal Government or services 
        assisted or subsidized to any significant extent by the 
        Federal Government.

SEC. 1213. REQUIREMENTS WITH RESPECT TO CARRYING OUT PURPOSE OF 
                    ALLOTMENTS.

  (a) Trauma Care Modifications to State Plan for Emergency 
Medical Services.--With respect to the trauma care component of 
a State plan for the provision of emergency medical services, 
the modifications referred to in section 1211(b) are such 
modifications to the State plan as may be necessary for the 
State involved to ensure that the plan provides for access to 
the highest possible quality of trauma care, and that the 
plan--
          (1) specifies that the modifications required 
        pursuant to paragraphs (2) through (11) will be 
        implemented by the principal State agency with respect 
        to emergency medical services or by the designee of 
        such agency;
          (2) specifies a public or private entity that will 
        designate trauma care regions and trauma centers in the 
        State;
          (3) subject to subsection (b), contains national 
        standards and requirements of the American College of 
        Surgeons or another appropriate entity for the 
        designation of level I and level II trauma centers, and 
        in the case of rural areas level III trauma centers 
        (including trauma centers with specified capabilities 
        and expertise in the care of pediatric trauma 
        patients), by such entity, including standards and 
        requirements for--
                  (A) the number and types of trauma patients 
                for whom such centers must provide care in 
                order to ensure that such centers will have 
                sufficient experience and expertise to be able 
                to provide quality care for victims of injury;
                  (B) the resources and equipment needed by 
                such centers; and
                  (C) the availability of rehabilitation 
                services for trauma patients;
          (4) contains standards and requirements for the 
        implementation of regional trauma care systems, 
        including standards and guidelines (consistent with the 
        provisions of section 1867 of the Social Security Act) 
        for medically directed triage and transportation of 
        trauma patients (including patients injured in rural 
        areas) prior to care in designated trauma centers;
          (5) subject to subsection (b), contains national 
        standards and requirements, including those of the 
        American Academy of Pediatrics and the American College 
        of Emergency Physicians, for medically directed triage 
        and transport of severely injured children to 
        designated trauma centers with specified capabilities 
        and expertise in the care of pediatric trauma patients;
          (6) utilizes a program with procedures for the 
        evaluation of designated trauma centers (including 
        trauma centers described in paragraph (5)) and trauma 
        care systems;
          (7) provides for the establishment and collection of 
        data in accordance with data collection requirements 
        developed in consultation with surgical, medical, and 
        nursing specialty groups, State and local emergency 
        medical services directors, and other trained 
        professionals in trauma care, from each designated 
        trauma center in the State of a central data reporting 
        and analysis system--
                  (A) to identify the number of severely 
                injured trauma patients and the number of 
                deaths from trauma within trauma care systems 
                in the State;
                  (B) to identify the cause of the injury and 
                any factors contributing to the injury;
                  (C) to identify the nature and severity of 
                the injury;
                  (D) to monitor trauma patient care (including 
                prehospital care) in each designated trauma 
                center within regional trauma care systems in 
                the State (including relevant emergency-
                department discharges and rehabilitation 
                information) for the purpose of evaluating the 
                diagnosis, treatment, and treatment outcome of 
                such trauma patients;
                  (E) to identify the total amount of 
                uncompensated trauma care expenditures for each 
                fiscal year by each designated trauma center in 
                the State; and
                  (F) to identify patients transferred within a 
                regional trauma system, including reasons for 
                such transfer and the outcomes of such 
                patients;
          (8) provides for the use of procedures by paramedics 
        and emergency medical technicians to assess the 
        severity of the injuries incurred by trauma patients;
          (9) provides for appropriate transportation and 
        transfer policies to ensure the delivery of patients to 
        designated trauma centers and other facilities within 
        and outside of the jurisdiction of such system, 
        including policies to ensure that only individuals 
        appropriately identified as trauma patients are 
        transferred to designated trauma centers, and to 
        provide periodic reviews of the transfers and the 
        auditing of such transfers that are determined to be 
        appropriate;
          (10) conducts public education activities concerning 
        injury prevention and obtaining access to trauma care;
          (11) coordinates planning for trauma systems with 
        State disaster emergency planning and bioterrorism 
        hospital preparedness planning; and
          (12) with respect to the requirements established in 
        this subsection, provides for coordination and 
        cooperation between the State and any other State with 
        which the State shares any standard metropolitan 
        statistical area.
  (b) Certain Standards With Respect to Trauma Care Centers and 
Systems.--
          (1) In general.--The Secretary may not make payments 
        under section 1211(a) for a fiscal year unless the 
        State involved agrees that, in carrying out paragraphs 
        (3) through (5) of subsection (a), the State will adopt 
        standards for the designation of trauma centers, and 
        for triage, transfer, and transportation policies, and 
        that the State will, in adopting such standards--
                  (A) take into account national standards that 
                outline resources for optimal care of injured 
                patients;
                  (B) consult with medical, surgical, and 
                nursing speciality groups, hospital 
                associations, emergency medical services State 
                and local directors, concerned advocates, and 
                other interested parties;
                  (C) conduct hearings on the proposed 
                standards after providing adequate notice to 
                the public concerning such hearing; and
                  (D) beginning in fiscal year 2008, take into 
                account the model plan described in subsection 
                (c).
          (2) Quality of trauma care.--The highest quality of 
        trauma care shall be the primary goal of State 
        standards adopted under this subsection.
          (3) Approval by the secretary.--The Secretary may not 
        make payments under section 1211(a) to a State if the 
        Secretary determines that--
                  (A) in the case of payments for fiscal year 
                2008 and subsequent fiscal years, the State has 
                not taken into account national standards, 
                including those of the American College of 
                Surgeons, the American College of Emergency 
                Physicians, and the American Academy of 
                Pediatrics, in adopting standards under this 
                subsection; or
                  (B) in the case of payments for fiscal year 
                2008 and subsequent fiscal years, the State has 
                not, in adopting such standards, taken into 
                account the model plan developed under 
                subsection (c).
  (c) Model Trauma Care Plan.--
          (1) In general.--Not later than 1 year after the date 
        of the enactment of the Trauma Care Systems Planning 
        and Development Act of 2007, the Secretary shall update 
        the model plan for the designation of trauma centers 
        and for triage, transfer, and transportation policies 
        that may be adopted for guidance by the State. Such 
        plan shall--
                  (A) take into account national standards, 
                including those of the American College of 
                Surgeons, American College of Emergency 
                Physicians, and the American Academy of 
                Pediatrics;
                  (B) take into account existing State plans;
                  (C) be developed in consultation with 
                medical, surgical, and nursing speciality 
                groups, hospital associations, emergency 
                medical services State directors and 
                associations, and other interested parties; and
                  (D) include standards for the designation of 
                rural health facilities and hospitals best able 
                to receive, stabilize, and transfer trauma 
                patients to the nearest appropriate designated 
                trauma center, and for triage, transfer, and 
                transportation policies as they relate to rural 
                areas.
          (2) Applicability.--Standards described in paragraph 
        (1)(D) shall be applicable to all rural areas in the 
        State, including both non-metropolitan areas and 
        frontier areas that have populations of less than 6,000 
        per square mile.
  (d) Rule of Construction With Respect to Number of Designated 
Trauma Centers.--With respect to compliance with subsection (a) 
as a condition of the receipt of a grant under section 1211(a), 
such subsection may not be construed to specify the number of 
trauma care centers designated pursuant to such subsection.

SEC. 1214. REQUIREMENT OF SUBMISSION TO SECRETARY OF TRAUMA PLAN AND 
                    CERTAIN INFORMATION.

  (a) In General.--For each fiscal year, the Secretary may not 
make payments to a State under section 1211(a) unless, subject 
to subsection (b), the State submits to the Secretary the 
trauma care component of the State plan for the provision of 
emergency medical services, including any changes to the trauma 
care component and any plans to address deficiencies in the 
trauma care component.
  (b) Interim Plan or Description of Efforts.--For each fiscal 
year, if a State has not completed the trauma care component of 
the State plan described in subsection (a), the State may 
provide, in lieu of such completed component, an interim 
component or a description of efforts made toward the 
completion of the component.
  (c) Information Received by State Reporting and Analysis 
System.--The Secretary may not make payments to a State under 
section 1211(a) unless the State agrees that the State will, 
not less than once each year, provide to the Secretary the 
information received by the State pursuant to section 
1213(a)(7).
  (d) Availability of Emergency Medical Services in Rural 
Areas.--The Secretary may not make payments to a State under 
section 1211(a) unless--
          (1) the State identifies any rural area in the State 
        for which--
                  (A) there is no system of access to emergency 
                medical services through the telephone number 
                911;
                  (B) there is no basic life-support system; or
                  (C) there is no advanced life-support system; 
                and
          (2) the State submits to the Secretary a list of 
        rural areas identified pursuant to paragraph (1) or, if 
        there are no such areas, a statement that there are no 
        such areas.

SEC. 1215. RESTRICTIONS ON USE OF PAYMENTS.

  (a) In General.--The Secretary may not, except as provided in 
subsection (b), make payments under section 1211(a) for a 
fiscal year unless the State involved agrees that the payments 
will not be expended--
          (1) for any purpose other than developing, 
        implementing, and monitoring the modifications required 
        by section 1211(b) to be made to the State plan for the 
        provision of emergency medical services;
          (2) to make cash payments to intended recipients of 
        services provided pursuant to this section;
          (3) to purchase or improve real property (other than 
        minor remodeling of existing improvements to real 
        property);
          (4) to satisfy any requirement for the expenditure of 
        non-Federal funds as a condition for the receipt of 
        Federal funds; or
          (5) to provide financial assistance to any entity 
        other than a public or nonprofit private entity.
  (b) Waiver.--The Secretary may waive a restriction under 
subsection (a) only if the Secretary determines that the 
activities outlined by the State plan submitted under section 
1214(a) by the State involved cannot otherwise be carried out.

           *       *       *       *       *       *       *


[SEC. 1222. REPORT BY SECRETARY.

  [Not later than October 1, 1995, the Secretary shall report 
to the appropriate committees of Congress on the activities of 
the States carried out pursuant to section 1211. Such report 
shall include an assessment of the extent to which Federal and 
State efforts to develop systems of trauma care and to 
designate trauma centers have reduced the incidence of 
mortality, and the incidence of permanent disability, resulting 
from trauma. Such report may include any recommendations of the 
Secretary for appropriate administrative and legislative 
initiatives with respect to trauma care.]

SEC. 1222. REPORT BY SECRETARY.

  Not later than October 1, 2008, the Secretary shall report to 
the appropriate committees of Congress on the activities of the 
States carried out pursuant to section 1211. Such report shall 
include an assessment of the extent to which Federal and State 
efforts to develop systems of trauma care and to designate 
trauma centers have reduced the incidence of mortality, and the 
incidence of permanent disability, resulting from trauma. Such 
report may include any recommendations of the Secretary for 
appropriate administrative and legislative initiatives with 
respect to trauma care.

           *       *       *       *       *       *       *


Part C--General Provisions Regarding Parts A and B

           *       *       *       *       *       *       *


[SEC. 1232. FUNDING.

  [(a) Authorization of Appropriations.--For the purpose of 
carrying out parts A and B, there are authorized to be 
appropriated $6,000,000 for fiscal year 1994, and such sums as 
may be necessary for each of the fiscal years 1995 through 
2002.
  [(b) Allocation of Funds by Secretary.--
          [(1) General authority.--For the purpose of carrying 
        out part A, the Secretary shall make available 10 
        percent of the amounts appropriated for a fiscal year 
        under subsection (a).
          [(2) Rural grants.--For the purpose of carrying out 
        section 1204, the Secretary shall make available 10 
        percent of the amounts appropriated for a fiscal year 
        under subsection (a).
          [(3) Formula grants.--
                  [(A) For the purpose of making allotments 
                under section 1211(a), the Secretary shall, 
                subject to subsection (c), make available 80 
                percent of the amounts appropriated for a 
                fiscal year pursuant to subsection (a).
                  [(B) Amounts paid to a State under section 
                1211(a) for a fiscal year shall, for the 
                purposes for which the amounts were paid, 
                remain available for obligation until the end 
                of the fiscal year immediately following the 
                fiscal year for which the amounts were paid.
  [(c) Effect of Insufficient Appropriations for Minimum 
Allotments.--
          [(1) In general.--If the amounts made available under 
        subsection (b)(3)(A) for a fiscal year are insufficient 
        for providing each State with an allotment under 
        section 1211(a) of not less than the applicable amount 
        under section 1218(a)(2), the Secretary shall, from 
        such amounts as are made available under subsection 
        (b)(3)(A), make grants to States described in paragraph 
        (2) for carrying out part B.
          [(2) Eligible states.--The States referred to in 
        paragraph (1) are States that--
                  [(A) have the greatest need to develop, 
                implement, and maintain trauma care systems; 
                and
                  [(B) demonstrate in their applications under 
                section 1217 the greatest commitment to 
                establishing and maintaining such systems.
          [(3) Rule of construction.--Paragraph (1) may not be 
        construed to require the Secretary to make a grant 
        under such paragraph to each State.]

SEC. 1232. FUNDING.

  (a) Authorization of Appropriations.--For the purpose of 
carrying out parts A and B, subject to subsections (b) and (c), 
there are authorized to be appropriated $12,000,000 for fiscal 
year 2008, $10,000,000 for fiscal year 2009, and $8,000,000 for 
each of the fiscal years 2010 through 2012.
  (b) Reservation of Funds.--If the amount appropriated under 
subsection (a) for a fiscal year is equal to or less than 
$1,000,000, such appropriation is available only for the 
purpose of carrying out part A. If the amount so appropriated 
is greater than $1,000,000, 50 percent of such appropriation 
shall be made available for the purpose of carrying out part A 
and 50 percent shall be made available for the purpose of 
carrying out part B.
  (c) Allocation of Part A Funds.--Of the amounts appropriated 
under subsection (a) for a fiscal year to carry out part A--
          (1) 10 percent of such amounts for such year shall be 
        allocated for administrative purposes; and
          (2) 10 percent of such amounts for such year shall be 
        allocated for the purpose of carrying out section 1202.

           *       *       *       *       *       *       *


                     Part E--Miscellaneous Programs

[SEC. 1251. RESIDENCY TRAINING PROGRAMS IN EMERGENCY MEDICINE.

  [(a) In General.--The Secretary may make grants to public and 
nonprofit private entities for the purpose of planning and 
developing approved residency training programs in emergency 
medicine.
  [(b) Identification and Referral of Domestic Violence.--The 
Secretary may make a grant under subsection (a) only if the 
applicant involved agrees that training programs under 
subsection (a) will provide education and training in 
identifying and referring cases of domestic violence.
  [(c) Authorization of Appropriations.--For the purpose of 
carrying out this section, there is authorized to be 
appropriated $400,000 for each of the fiscal years 1993 through 
1995.]

SEC. 1251. RESIDENCY TRAINING PROGRAMS IN EMERGENCY MEDICINE.

  (a) In General.--The Secretary may make grants to public and 
nonprofit private entities for the purpose of planning and 
developing approved residency training programs in emergency 
medicine.
  (b) Identification and Referral of Domestic Violence.--The 
Secretary may make a grant under subsection (a) only if the 
applicant involved agrees that the training programs under 
subsection (a) will provide education and training in 
identifying and referring cases of domestic violence.
  (c) Authorization of Appropriations.--For the purpose of 
carrying out this section, there is authorized to be 
appropriated $400,000 for each of the fiscal years 2008 though 
2012.

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

  (a) * * *

           *       *       *       *       *       *       *


                                  
