[Senate Report 110-140]
[From the U.S. Government Publishing Office]





                                                       Calendar No. 317
110th Congress                                                   Report
                                 SENATE
 1st Session                                                    110-140

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



 
           REAUTHORIZATION OF THE TRAUMATIC BRAIN INJURY ACT

                                _______
                                

                 August 1, 2007.--Ordered to be printed

                                _______
                                

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

                                 REPORT

                         [To accompany S. 793]

    The Committee on Health, Education, Labor, and Pensions, to 
which was referred the bill (S. 793) to provide for the 
expansion and improvement of traumatic brain injury programs, 
having considered the same, reports favorably thereon with an 
amendment in the nature of a substitute and recommends that the 
bill do pass.

                                CONTENTS

                                                                   Page
  I. Purpose and Need for Legislation.................................1
 II. Summary..........................................................2
III. History of Legislation and Votes in Committee....................3
 IV. Explanation of Bill and Committee Views..........................4
  V. Cost Estimate....................................................5
 VI. Regulatory Impact Statement......................................6
VII. Application of Law to the Legislative Branch.....................6
VIII.Section-by-Section Analysis......................................6

 IX. Changes in Existing Law..........................................8

                  I. Purpose and Need for Legislation

    The purpose of the ``Reauthorization of the Traumatic Brain 
Injury Act'' is to direct the Secretary of Health and Human 
Services (HHS) to expand and intensify programs with respect to 
research and related activities concerning traumatic brain 
injury (TBI). Every year, of the 1.5 million people in the 
United States who sustain a TBI, 50,000 die and 235,000 are 
hospitalized. Estimates show that at a minimum, brain injuries 
cost the United States $60 billion per year.
    TBI is defined as brain damage from externally inflicted 
trauma to the head resulting in significant impairment to an 
individual's physical, psychosocial, and/or cognitive 
functional abilities. According to CDC, brain injuries are 
among the most likely types of injury to cause death or 
permanent disability. People ages 15 to 24 years and those over 
age 75 are the two age groups at highest risk for TBI. Motor 
vehicle accidents, sports accidents, falls, and violence are 
the major causes of TBI. Whereas motor vehicle accidents and 
violence, such as firearm assaults and child abuse, account for 
70 percent of TBI in the overall U.S. population, falling is 
the major cause in people aged 75 years or older.
    TBI is also caused by explosives, and medical experts have 
described it as the signature wound of the Iraq war. Up to two-
thirds of injuries in the Iraq war may be brain injuries.
    Long known as the silent epidemic, TBI can strike anyone--
infant, youth, or elderly person--without warning and with 
devastating results. It is particularly common among young 
males and people of both sexes who are 75 years and older. TBI 
affects the whole family and often results in huge medical and 
rehabilitation expenses over a lifetime.
    TBI is different from other disabilities due to the 
severity of cognitive loss. Most rehabilitation programs are 
designed for people with physical disabilities, not cognitive 
disabilities that require special accommodations. Finding 
needed services is typically a logistical, financial, and 
psychological challenge for family members and other 
caregivers, because few coordinated systems of care exist for 
individuals with TBI. The passage of the Traumatic Brain Injury 
Act of 1996 has improved TBI service systems at the state-level 
and also increased the overall visibility of TBI. However, more 
work needs to be done at both the national and State level to 
build an effective, durable service system for meeting the 
needs of individuals with TBI and their families.

                              II. Summary

    The purpose of this legislation is to expand and improve 
programs that authorize activities related to TBI. With respect 
to TBI, the legislation authorizes three Federal agencies to 
carry out activities addressing TBI:
    (1) The Centers for Disease Control and Prevention (CDC) 
carries out projects that reduce the incidence of TBI through 
research, public education, and a national education and 
awareness campaign, gives grants to States to operate TBI 
registries, and funds academic research supporting the 
development of registries.
    (2) Supports basic and applied research conducted by 
National Institutes of Health (NIH).
    (3) Health Resources Service Administration (HRSA) awards 
grants to fund State demonstration projects to improve access 
to health and other services and for protection and advocacy 
service systems.

           III. History of Legislation and Votes in Committee

    The Traumatic Brain Injury Act Reauthorization of 2006 was 
introduced by Senator Hatch for himself and Senator Kennedy on 
July 16, 2006. In an effort to promote injury prevention 
activities, the bill was included as part of package along with 
the Keeping Seniors Safe from Falls Act (S. 1531). The package 
was reported favorably by the committee on September 20, 2006; 
however, the package was not considered by the full Senate 
before the adjournment of the 109th Congress.
    The original Traumatic Brain Injury Act, introduced by 
Senator Hatch for himself and Senator Kennedy, was signed into 
law (P.L. 104-166) on July 29, 1996. On September 20, 2000, 
Senator Hatch introduced the Traumatic Brain Injury Act 
Amendments of 2000 to reauthorize the program. The bill was 
included as part of the Children's Health Act (P.L. 106-310), 
which was signed into law on October 17, 2000.

              IV. Explanation of Bill and Committee Views

    The Reauthorization of Traumatic Brain Injury Act directs 
the Secretary of HHS to intensify and expand the Department's 
efforts to prevent and treat brain injuries. The committee 
authorizes from 2008 through 2011 such sums as may be necessary 
for TBI programs administered by the Centers for Disease 
Control and Prevention (CDC), the Health Resources Service 
Administration (HRSA) and the National Institutes of Health 
(NIH).
    Minor changes are made to TBI activities administered by 
CDC and NIH to improve prevention and research activities. A 
collaborative study between CDC and NIH is authorized to 
determine the incidence and prevalence of TBI; collect, 
maintain and report national trends; identify common 
therapeutic interventions; and develop practice guidelines. The 
committee also sees it necessary for other Federal agencies 
such as the Department of Defense (DOD), which conducts TBI 
research, to be consulted for the report. This will more 
effectively coordinate and maximize efforts at the Federal 
level to better understand TBI.
    The HRSA grant program was amended to improve access to 
rehabilitation and other services related to TBI. Recognizing 
that TBI is a leading cause of death and disability among 
American Indians/Alaska Indians, tribal communities are 
eligible to apply for grants. The efficiency of protection and 
advocacy grants is strengthened by directing HRSA and 
Administration on Developmental Disabilities (ADD) to 
coordinate data collection related to services. Payments for 
grants shall be distributed no later than October 1 of each 
fiscal year.
    Although the committee does not have jurisdiction over 
military issues, the committee is concerned about the impact of 
TBI on military personnel. In prior conflicts, TBI was present 
in at least 14-20 percent of surviving combat casualties; 
preliminary data regarding the current conflict in the Middle 
East suggests that this number is now much higher. TBI is a 
major cause of life-long disability and death; and certain 
military assignments carry above-average risk for TBI.
    The committee recognizes the efforts of the Defense and 
Veterans Brain Injury Center (DVBIC), a collaborative program 
of the Department of Defense and the Department of Veterans 
Affairs that integrates clinical care with applied research, 
treatment and training at seven Department of Defense and VA 
hospitals and two civilian partner sites.
    In order to gather more information about the growing 
impact of traumatic brain injuries on our soldiers, two studies 
are authorized. The act authorizes a CDC study in collaboration 
with NIH, DOD, and VA to identify methods of improving data 
collection and collaboration of registries, and a GAO study is 
requested in order to determine the extent to which soldiers 
who have sustained a TBI are being reintegrated into their 
communities. The GAO study will examine availability of 
suitable housing, transportation, and employment, and study the 
capacity and coordination of community care received by 
veterans.

                            V. Cost Estimate

                                     U.S. Congress,
                               Congressional Budget Office,
                                     Washington, DC, July 23, 2007.
Hon. Edward M. Kennedy, Chairman,
Committee on Health, Education, Labor and Pensions,
U.S. Senate, Washington, DC.
    Dear Mr. Chairman: The Congressional Budget Office has 
prepared the enclosed cost estimate for S. 793, the 
Reauthorization of the Traumatic Brain Injury Act.
    If you wish further details on this estimate, we will be 
pleased to provide them. The CBO staff contacts are Sarah Evans 
and Tim Gronniger.
            Sincerely,
                                           Peter R. Orszag,
                                                          Director.
    Enclosure.

S. 793--Reauthorization of the Traumatic Brain Injury Act

    Summary: S. 793 would amend the Public Health Services Act 
to authorize research and public health activities related to 
trauma and traumatic brain injury (TBI). CBO estimates that 
implementing the bill would cost $106 million in 2008 and $1.5 
billion over the 2008-2012 period, subject to the appropriation 
of the necessary amounts. Enacting S. 793 would not affect 
direct spending or federal revenues.
    S. 793 contains no intergovernmental or private-sector 
mandates as defined in the Unfunded Mandates Reform Act (UMRA); 
any costs to State governments and Indian consortia would 
result from complying with conditions of federal assistance.
    Estimated cost to the Federal Government: The estimated 
budgetary impact of S. 793 is shown in the following table. The 
costs of this legislation fall within budget function 550 
(health).
    Basis of estimate: S. 793 would authorize funding for 
research, treatment, surveillance, and education activities 
related to trauma and traumatic brian injury at the National 
Institutes of Health (NIH), the Health Resources and Services 
Administration (HRSA), and the Centers for Disease Control and 
Prevention (CDC). It also would direct the Government 
Accountability Office to conduct a study on the care for 
members of the armed forces who have acquired disabilities 
serving in Iraq. CBO estimates that those activities would 
require the appropriation of $373 million in 2008 and $1.5 
billion over the years 2008-2012. Assuming the appropriation of 
necessary amounts, CBO estimates that implementing S. 793 would 
cost $106 million in 2008 and $1.5 billion over the 2008-12 
period.

----------------------------------------------------------------------------------------------------------------
                                                               By fiscal year, in millions of dollars--
                                                     -----------------------------------------------------------
                                                        2007      2008      2009      2010      2011      2012
----------------------------------------------------------------------------------------------------------------
                                        SPENDING SUBJECT TO APPROPRIATION

Spending Under Current Law:
    Budget Authority\1\.............................       366         0         0         0         0         0
    Estimated Outlays...............................       367       263        59        11         4         0
Proposed Changes:
    Estimated Authorization Level\1\................         0       373       381       390       397         6
    Estimated Outlays...............................         0       106       315       370       386       285
Spending Under S. 793:
    Estimated Authorization Level\1\................       366       373       381       390       397         6
    Estimated Outlays...............................       367       369       374       381       390       285
----------------------------------------------------------------------------------------------------------------
\1\The 2007 level is the amount appropriated for that year for research and other federal activities related to
  traumatic brain injury.

    The NIH estimates that it will allocate $352 million for 
trauma-related activities in fiscal year 2007. S. 793 would 
authorize the appropriation of such sums as are necessary for 
those activities over the 2008-11 period. Based on historical 
program expenditures at NIH and adjusting for inflation, CBO 
estimates that NIH would require the appropriation of $359 
million for 2008 and $1.5 billion over the 2008-12 period to 
conduct the authorized activities. Implementing those programs 
would cost $101 million in 2008 and $1.4 billion over the 2008-
12 period, assuming appropriation of the necessary amounts.
    HRSA allocated $9 million in 2007 for grants to States to 
expand access to care and protection services for TBI. S. 793 
would authorize the appropriation of such sums as are necessary 
for those activities over the 2008-11 period, and would expand 
the program to allow consortia of American Indians to receive 
such grants. Based on historical spending of the programs, CBO 
estimates that the agency would require the appropriation of $9 
million in 2008 and $38 million over the 2008-11 period to 
carry out activities specified by the bill. CBO estimates that 
implementing those provisions of S. 793 would cost $3 million 
in 2008 and $34 million over the 2007-11 period, assuming 
appropriation of necessary amounts and that future rates of 
spending resemble historical patterns for similar activities.
    In 2007, the Centers for Disease Control and Prevention 
allocated $5 million for TBI-related activities, including 
grants to States' TBI surveillance programs and educational 
activities. S. 793 would authorize the appropriation of 
necessary amounts for those and other TBI-related activities, 
which CBO estimates would require $5 million in 2008 and $29 
million over the 2008-12 period. Based on historical spending 
patterns for those activities, and assuming appropriation of 
necessary amounts, CBO estimates that implementing S. 793's CDC 
provisions would cost $2 million in 2008 and $23 million over 
the 2008-12 period.
    Intergovernmental and private-sector impact: S. 793 
contains no intergovernmental or private-sector mandates as 
defined in UMRA. State governments and Indian consortia would 
benefit from grant funding authorized by the bill. Any costs 
incurred by those entities to qualify for such grants would be 
incurred voluntarily as conditions of Federal assistance.
    Estimate prepared by: Federal Costs: Sarah Evans and Tim 
Gronniger; Impact on state, local, and tribal governments: Lisa 
Ramirez-Branum; Impact on the private sector: Morgan Hanger.
    Estimate approved by: Peter H. Fontaine, Deputy Assistant 
Director for Budget Analysis.

                    VI. Regulatory Impact Statement

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

           VII. Application of Law to the Legislative Branch

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

                   VIII. Section-by-Section Analysis


Section 1. Short title

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

Section 2. Conforming amendments relating to restructuring

    Section 2 re-designates (1) Section 393B as section 393A;
    (2) Section 393A as section 393B; and
    (3) Section 393B as section 393C, so that Traumatic Brain 
Injury sections follow and are not interrupted by the rape 
prevention provision of PHSA.

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

    Section 3 amends part J of Title III of the Public Health 
Service Act as re-designated (42 U.S.C. 280b-1b) authorize the 
dissemination of information related to TBI and its secondary 
conditions upon an individual's discharge from hospitals and 
emergency centers.
    Section 393C of the Public Health Service Act, as re-
designated (42 U.S.C. 280B et seq), is amended to change the 
section heading to the ``National Program for Brain Injury 
Surveillance and Registries.'' This section authorizes grants 
to States or their designees to develop or operate the State's 
TBI surveillance system or registry to determine the incidence 
and prevalence of TBI. The Secretary is authorized to ensure 
the uniformity of reporting information. It also directs 
individuals with TBI to be linked with academic institutions to 
conduct applied research that will support the development of 
such surveillance systems and registries as necessary.
    This section also authorizes a new CDC study in 
collaboration with the National Institutes of Health, the 
Department of Defense, and the Department of Veteran's Affairs 
to examine methods of improving data collection and 
collaboration between civilian and military registries, as well 
as development of diagnostic tools and treatments for traumatic 
brain injuries.

Section 4. Study of traumatic brain injury

    Section 4 authorizes the CDC to conduct a study in 
coordination with the NIH to examine aspects of TBI. Aspects 
include determining the incidence and prevalence of TBI in all 
age groups; collecting, maintaining and reporting national 
trends; identifying interventions used for rehabilitation and 
their effectiveness; analyzing the adequacy of existing 
measures of outcomes and knowledge of factors influencing 
differential outcomes; and developing guidelines for patient 
rehabilitation after TBI.
    The report shall be submitted to Congress no later than 3 
years after the date of enactment.

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

    Section 5 reauthorizes the current grant program to conduct 
basic and clinical research on trauma, including diagnosis 
treatment rehabilitation, and general management of trauma and 
TBI.
    This section authorizes such sums as may be necessary for 
each of the fiscal years 2008-11.

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

    Section 6 reauthorizes the Secretary to award grants to 
States, and authorizes the Secretary to award grants to the 
American Indian consortium, for the purpose of carrying out 
projects to improve access to health and other services 
regarding TBI.
    This section authorizes the Secretary to submit to the 
committees of jurisdiction no less than biennially, a report 
describing the findings, and results of the programs 
established under this section.
    Definitions in this section include American Indian 
consortium and TBI.
    Grants are authorized for such sums as may be necessary for 
each of the fiscal years 2008 through 2011.
    This section authorizes the Secretary to award grants to 
protection and advocacy systems for the purpose of enabling 
such systems to provide services to individuals with TBI.
    This section directs the Administration to pay directly to 
any protection and advocacy system that complies with the 
provisions of this section, no later than October 1.
    This section requires the Administrator of Health Resources 
Service Administration and the Commissioner of the 
Administration of Developmental Disabilities to enter into an 
agreement to coordinate the collection of data by the 
Administrator and the Commissioner regarding protection and 
advocacy services.
    This section requires for any fiscal year for which the 
amount appropriated is $6 million or greater, the Administrator 
to use 2 percent of such amount to make a grant to an eligible 
national association for providing training and technical 
assistance for protection and advocacy systems.
    In this section, eligible national association means a 
national association with demonstrated experience in providing 
training and technical assistance to protection and advocacy 
systems.
    This section clarifies that protection and advocacy systems 
are allowed the same authorities as such a system would for the 
purpose of providing services under subtitle C of the 
Developmental Disabilities Assistance and Bill of Rights Act of 
2000.

Section 7. GAO study with respect to members of the armed forces

    This section requires a new GAO study to examine soldiers' 
re-integration into their communities following a traumatic 
brain injury. Factors to be studied include availability of 
housing, transportation, employment, and the capacity of 
community care systems and the coordination of care received. 
The section requires that a report to Congress be submitted 
within 180 days of enactment of the act.

                      IX. Changes in Existing Law

    In compliance with rule XXVI paragraph 12 of the Standing 
Rules of the Senate, the following provides a print of the 
statute or the part or section thereof to be amended or 
replaced (existing law proposed to be omitted is enclosed in 
black brackets, new matter is printed in italic, existing law 
in which no change is proposed is shown in roman):

PUBLIC HEALTH SERVICE ACT

           *       *       *       *       *       *       *


               Part J--Prevention and Control of Injuries

    Sec. 393. [280b-1a] (a) * * *

           *       *       *       *       *       *       *


SEC. [393B] 393A. [280B-1C] USE OF ALLOTMENTS FOR RAPE PREVENTION 
                    EDUCATION.

    (a) Permitted use.--* * *

           *       *       *       *       *       *       *


                  PREVENTION OF TRAUMATIC BRAIN INJURY

    Sec. [393A] 393B. [280b-1b] (a) In General.--* * *
    (b) Certain Activities.--Activities under subsection (a) 
may include--
          (1)  * * *

           *       *       *       *       *       *       *

          (3)  * * *
                  (A)  * * *
                          (i)  * * *
                          (ii) information relating to 
                        traumatic brain injury and the sequelae 
                        of secondary conditions arising from 
                        traumatic brian injury upon discharge 
                        [from hospitals and trauma centers] 
                        from hospitals and emergency 
                        departments; and

           *       *       *       *       *       *       *


NATIONAL PROGRAM FOR TRAUMATIC BRAIN INJURY SURVEILLANCE AND REGISTRIES

    Sec. [393B] 393C [280b-1d] (a) In General.--The Secretary, 
acting through the Director of the Centers for Disease Control 
and Prevention, [may make grants to States or their designees 
to operate the State's traumatic brain injury registry, and to 
academic institutions to conduct applied research that will 
support the development of such registries, to collect data 
concerning--] may make grants to States or their designees to 
develop or operate the State's traumatic brain injury 
surveillance system or registry to determine the incidence and 
prevalence of traumatic brain injury and related disability, to 
ensure the uniformity of reporting under such system or 
registry, to link individuals with traumatic brain injury to 
services and supports, and to link such individuals with 
academic institutions to conduct applied research that will 
support the development of such surveillance systems and 
registries as may be necessary. A surveillance system or 
registry under this section shall provide for the collection of 
data concerning--

           *       *       *       *       *       *       *

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

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

    (a) Study.--The Secretary, acting through the Director of 
the Centers for Disease Control and Prevention with respect to 
paragraph (1) and the Director of the National Institutes of 
Health with respect to paragraphs (2) and (3), shall conduct a 
study with respect to traumatic brain injury for the purpose of 
carrying out the following:
          (1) In collaboration with appropriate State and local 
        health-related agencies--
                  (A) determining the incidence of traumatic 
                brain injury and prevalence of traumatic brain 
                injury related disability and the clinical 
                aspects of the disability in all age groups and 
                racial and ethnic minority groups in the 
                general population of the United States, 
                including institutional settings, such as 
                nursing homes, correctional facilities, 
                psychiatric hospitals, child care facilities, 
                and residential institutes for people with 
                developmental disabilities; and
                  (B) reporting national trends in traumatic 
                brain injury.
          (2) Identifying common therapeutic interventions 
        which are used for the rehabilitation of individuals 
        with such injuries, and, subject to the availability of 
        information, including an analysis of--
                  (A) the effectiveness of each such 
                intervention in improving the functioning, 
                including return to work or school and 
                community participation, of individuals with 
                brain injuries;
                  (B) the comparative effectiveness of 
                interventions employed in the course of 
                rehabilitation of individuals with brain 
                injuries to achieve the same or similar 
                clinical outcome; and
                  (C) the adequacy of existing measures of 
                outcomes and knowledge of factors influencing 
                differential outcomes.
          (3) Identifying interventions and therapies that can 
        prevent or remediate the development of secondary 
        neurologic conditions related to traumatic brain 
        injury.
          (4) Developing practice guidelines for the 
        rehabilitation of traumatic brain injury at such time 
        as appropriate scientific research becomes available.
    (b) Dates Certain for Reports.--Not later than 3 years 
after the date of the enactment of the Reauthorization of the 
Traumatic Brain Injury Act, the Secretary shall submit to the 
Congress a report describing findings made as a result of 
carrying out subsection (a).
    (c) Definition.--For purposes of this section, the term 
`traumatic brain injury' means an acquired injury to the brain. 
Such term does not include brain dysfunction caused by 
congenital or degenerative disorders, nor birth trauma, but may 
include brain injuries caused by anoxia due to trauma including 
near drowning. The Secretary may revise the definition of such 
term as the Secretary determines necessary.

                   Part E--Miscellaneous Programs\1\


SEC. 1251. [300D-51] RESIDENCY TRAINING PROGRAMS IN EMERGENCY MEDICINE.

           *       *       *       *       *       *       *


SEC. 1252. [300D-52] STATE GRANTS FOR DEMONSTRATION PROJECTS REGARDING 
                    TRAUMATIC BRAIN INJURY.

    (a) In general.--The Secretary, acting through the 
Administrator of the Health Resources and Services 
Administration, [may make grants to States] may make grants to 
States and American Indian consortia for the purpose of 
carrying out projects to improve access to [health and other 
services] rehabilitation and other services regarding traumatic 
brain injury.
    (b) State Advisory Board.--
          (1) In general.--The Secretary may make a grant under 
        subsection (a) only if the [State] State or American 
        Indian consortium involved agrees to establish an 
        advisory board within the appropriate health department 
        of the [State] State or American Indian consortium or 
        within another department as designated by the chief 
        executive officer of the [State] State or American 
        Indian consortium
          (2) Functions.--An advisory board established under 
        paragraph (1) shall advise and make [recommendations to 
        the State] recommendations to the State or American 
        Indian consortium on ways to improve services 
        coordination regarding traumatic brain injury. Such 
        advisory boards shall encourage citizen participation 
        through the establishment of public hearings and other 
        types of community outreach programs. In developing 
        recommendations under this paragraph, such boards shall 
        consult with Federal, State, and local governmental 
        agencies and with citizens groups and other private 
        entities.
          (3) Composition.--* * *
                  (A) * * *
                          (i) the corresponding [State] State 
                        or American Indian consortium agencies 
                        involved;
                          (ii) * * *
                          (iii) other disability advisory or 
                        planning groups within the [State] 
                        State or American Indian consortium;
                          (iv) members of an organization or 
                        foundation representing individuals 
                        with traumatic brain injury in that 
                        [State] State or American Indian 
                        consortium; and
    (c) Matching Funds.--
          (1) In general.--With respect to the costs to be 
        incurred by a [State] State or American Indian 
        consortium in carrying out the purpose described in 
        subsection (a), the Secretary may make a grant under 
        such subsection only if the [State] State or American 
        Indian consortium agrees to make available non-Federal 
        contributions toward such costs in an amount that is 
        not less than $1 for each $2 of Federal funds provided 
        under the grant.

           *       *       *       *       *       *       *

    (e) Continuation of Previously Awarded Demonstration 
Projects.--[A State that received a grant under this section 
prior to the date of the enactment of the Children's Health Act 
of 2000 may compete for new project grants under this section 
after such date of the enactment.] A State or American Indian 
consortium that received a grant under this section prior to 
the date of the enactment of the Reauthorization of the 
Traumatic Brain Injury Act may complete the activities funded 
by the grant.
    (f) Use of [State] and American Indian Consortium Grants.--
          (1) Community services and supports.--A [State] State 
        or American Indian consortium shall (directly or 
        through awards of contracts to nonprofit private 
        entities) use amounts received under a grant under this 
        section for the following:
                  (A) * * *

           *       *       *       *       *       *       *

                          (i) * * *
                          (ii) shall be designed for [children 
                        and other individuals] children, youth, 
                        and adults with traumatic brain injury.

           *       *       *       *       *       *       *

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

           *       *       *       *       *       *       *

                  (E) tailor existing [State] State or American 
                Indian consortium systems to provide 
                accommodations to the needs of individuals with 
                brain injury (including systems administered by 
                the [State] State or American Indian consortium 
                departments responsible for health, mental 
                health, labor/employment, education, mental 
                retardation/developmental disorders, 
                transportation, and correctional systems);
                  (F) improve data sets coordinated across 
                systems and other needs identified by a [State] 
                State or American Indian consortium plan 
                supported by its advisory council; and
    (h) Report.--[Not later than 2 years after the date of the 
enactment of this section, the Secretary] Not less than 
biennially, the Secretary shall submit to the Committee on 
[Commerce of the House of Representatives, and to the Committee 
on Labor and Human Resources] Energy and Commerce of the House 
of Representatives, and to the Committee on Health, Education, 
Labor, and Pensions of the Senate, a report describing the 
findings and results of the programs established under this 
section, and section 1253 including measures of outcomes and 
consumer and surrogate satisfaction.
    [(i) Definition.--For purposes of this section, the term 
``traumatic brain injury'' means an acquired injury to the 
brain. Such term does not include brain dysfunction caused by 
congenital or degenerative disorders, nor birth trauma, but may 
include brain injuries caused by anoxia due to trauma. The 
Secretary may revise the definition of such term as the 
Secretary determines necessary, after consultation with States 
and other appropriate public or nonprofit private entities.]
    (i) Definitions.--For purposes of this section:
          (1) The terms ``American Indian consortium'' and 
        ``State'' have the meanings given to those terms in 
        section 1253.
          (2) The term ``traumatic brain injury'' means an 
        acquired injury to the brain. Such term does not 
        include brain dysfunction caused by congenital or 
        degenerative disorders, nor birth trauma, but may 
        include brain injuries caused by anoxia due to trauma. 
        The Secretary may revise the definition of such term as 
        the Secretary determines necessary, after consultation 
        with States and other appropriate public or non-profit 
        private entities.
    (j) Authorization of Appropriations.--For the purposes of 
carrying out this section, there are authorized to be 
appropriated such sums as may be necessary for each of the 
fiscal years 2001 through 2005 and such sums as may be 
necessary for each of the fiscal years 2008 through 2011.

           *       *       *       *       *       *       *


SEC. 1253. [300D-53] STATE GRANTS FOR PROTECTION AND ADVOCACY SERVICES.

    (a) In General.--* * *

           *       *       *       *       *       *       *

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

           *       *       *       *       *       *       *

          (4) Inflation Adjustment.--For each fiscal year in 
        which the total amount appropriated under [subsection 
        (i)] subsection (l) to carry out this section is 
        $5,000,000 or more, and such appropriated amount 
        exceeds the total amount appropriated to carry out this 
        section in the preceding fiscal year, the Administrator 
        shall increase each of the minimum grants amount 
        described in subparagraphs (A) and (B) of paragraph (3) 
        by a percentage equal to the percentage increase in the 
        total amount appropriated under [subsection (i)] 
        subsection (l) to carry out this section between the 
        preceding fiscal year and the fiscal year involved.
    (f) * * *
    (g) Direct Payment.--Notwithstanding any other provision of 
law, each fiscal year not later than October 1, the 
Administrator shall pay directly to any protection and advocacy 
system that complies with the provisions of this section, the 
total amount of the grant for such system, unless the system 
provides otherwise for such payment.
    (h) * * *

           *       *       *       *       *       *       *

    (i) Data Collection.--The Administrator of the Health 
Resources and Services Administration and the Commissioner of 
the Administration on Developmental Disabilities shall enter 
into an agreement to coordinate the collection of data by the 
Administrator and the Commissioner regarding protection and 
advocacy services.
    (j) Training and Technical Assistance.--
          (1) Grants.--For any fiscal year for which the amount 
        appropriated to carry out this section is $6,000,000 or 
        greater, the Administrator shall use 2 percent of such 
        amount to make a grant to an eligible national 
        association for providing for training and technical 
        assistance to protection and advocacy systems.
          (2) Definition.--In this subsection, the term 
        ``eligible national association'' means a national 
        association with demonstrated experience in providing 
        training and technical assistance to protection and 
        advocacy systems.
    (k) System Authority.--In providing services under this 
section, a protection and advocacy system shall have the same 
authorities, including access to records, as such system would 
have the purposes of providing services under subtitle C of the 
Developmental Disabilities Assistance and Bill of Rights Act of 
2000.
    [(i)] (l) Authorization of Appropriations.--There are 
authorized to be appropriated to carry out this section 
$5,000,000 for fiscal year 2001, and such sums as may be 
necessary for each of the fiscal years 2002 through [2005] 
2011.
    [(j)] (m) Definitions.--In this section:

           *       *       *       *       *       *       *


                         TITLE XII--TRAUMA CARE


Part A--General Authority and Duties of Secretary

           *       *       *       *       *       *       *



            Part F--Interagency Program for Trauma Research


SEC. 1261. [300D-61] ESTABLISHMENT OF PROGRAM.

    (a) In General.--* * *
    (b) Plan for Program.--
          (1) In General.--* * *
          (2) Submission to Congress.--Not later than December 
        1, 1993, the Director shall submit the plan required in 
        paragraph (1) to the Committee on Energy and Commerce 
        of the House of Representatives, and to the Committee 
        on [Labor and Human Resources] Health, Education, 
        Labor, and Pensions of the Senate, together with an 
        estimate of the funds needed for each of the fiscal 
        years 1994 through 1996 to implement the plan.
    (c) * * *

           *       *       *       *       *       *       *

    (d) Certain Activities of Program.--* * *
          (1) * * *

           *       *       *       *       *       *       *

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

           *       *       *       *       *       *       *

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

           *       *       *       *       *       *       *

    (i) Authorization of Appropriations.--For the purpose of 
carrying out this section, there are authorized to be 
appropriated such sums as may be necessary for each of the 
fiscal years 2001 through 2005, and such sums as may be 
necessary for each of fiscal years 2008 through 2011.

           *       *       *       *       *       *       *


                                  
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