[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.
* * * * * * *