[House Report 118-518]
[From the U.S. Government Publishing Office]


118th Congress   }                                     {        Report
                        HOUSE OF REPRESENTATIVES
 2d Session      }                                     {       118-518

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



 
DENNIS JOHN BENINGO TRAUMATIC BRAIN INJURY PROGRAM REAUTHORIZATION ACT 
                                OF 2024

                                _______
                                

  May 22, 2024.--Committed to the Committee of the Whole House on the 
              State of the Union and ordered to be printed

                                _______
                                

Mrs. Rodgers of Washington, from the Committee on Energy and Commerce, 
                        submitted the following

                              R E P O R T

                        [To accompany H.R. 7208]

    The Committee on Energy and Commerce, to whom was referred 
the bill (H.R. 7208) to reauthorize the Traumatic Brain Injury 
program, having considered the same, reports favorably thereon 
with an amendment and recommends that the bill as amended do 
pass.

                                CONTENTS

                                                                   Page
Purpose and Summary..............................................     2
Background and Need for Legislation..............................     2
Committee Action.................................................     3
Committee Votes..................................................     4
Oversight Findings and Recommendations...........................     6
New Budget Authority, Entitlement Authority, and Tax Expenditures     6
Congressional Budget Office Estimate.............................     6
Federal Mandates Statement.......................................     6
Statement of General Performance Goals and Objectives............     6
Duplication of Federal Programs..................................     6
Related Committee and Subcommittee Hearings......................     6
Committee Cost Estimate..........................................     7
Earmark, Limited Tax Benefits, and Limited Tariff Benefits.......     7
Advisory Committee Statement.....................................     7
Applicability to Legislative Branch..............................     7
Section-by-Section Analysis of the Legislation...................     7
Changes in Existing Law Made by the Bill, as Reported............     8

    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 ``Dennis John Beningo Traumatic Brain 
Injury Program Reauthorization Act of 2024''.

SEC. 2. NATIONAL PROGRAM FOR TRAUMATIC BRAIN INJURY SURVEILLANCE AND 
                    REGISTRIES.

  Section 393C of the Public Health Service Act (42 U.S.C. 280b-1d) is 
amended by striking subsection (b).

SEC. 3. PREVENTION AND CONTROL OF INJURIES.

  Section 394A(b) of the Public Health Service Act (42 U.S.C. 280b-
3(b)) is amended by striking ``fiscal years 2020 through 2024'' and 
inserting ``fiscal years 2025 through 2029''.

SEC. 4. STATE GRANTS FOR PROJECTS REGARDING TRAUMATIC BRAIN INJURY.

  Section 1252 of the Public Health Service Act (42 U.S.C. 300d-52) is 
amended--
          (1) in subsection (c)(1), by striking ``that is not less than 
        $1 for each $2 of Federal funds provided under the grant.'' and 
        inserting the following: ``that is--
                  ``(A) for fiscal years 2020 through 2024, not less 
                than $1 for each $2 of Federal funds provided under the 
                grant; and
                  ``(B) for fiscal year 2025 and each succeeding fiscal 
                year, not less than $0.50 for each $2 of Federal funds 
                provided under the grant.'';
          (2) by striking subsection (e);
          (3) by redesignating subsections (f) through (i) as 
        subsections (e) through (h), respectively;
          (4) by amending subsection (g)(2), as so redesignated, to 
        read as follows:
          ``(2)(A) The term `traumatic brain injury' means an acquired 
        injury to the brain.
          ``(B) Such term--
                  ``(i) does not include brain dysfunction caused by 
                congenital or degenerative disorders, nor birth trauma; 
                and
                  ``(ii) may include--
                          ``(I) brain injuries caused by anoxia due to 
                        trauma; and
                          ``(II) damage to the brain from an internal 
                        or external source that results in toxicity, 
                        surgery, or vascular disorders not associated 
                        with aging.
          ``(C) The Secretary may revise the definition of such term as 
        the Secretary determines necessary, after consultation with 
        States and other appropriate public or nonprofit private 
        entities.''; and
          (5) in subsection (i), as so redesignated, by striking 
        ``fiscal years 2020 through 2024'' and inserting ``fiscal years 
        2025 through 2029''.

SEC. 5. STATE GRANTS FOR PROTECTION AND ADVOCACY SERVICES.

  Section 1253(l) of the Public Health Service Act (42 U.S.C. 300d-
53(l)) is amended by striking ``fiscal years 2020 through 2024'' and 
inserting ``fiscal years 2025 through 2029''.

SEC. 6. REPORT ON DESIGNATING BRAIN INJURY AS A CHRONIC CONDITION.

  The Secretary of Health and Human Services, acting through the 
Director of the Centers for Disease Control and Prevention, shall--
          (1) examine the evidence base for designating brain injury as 
        a chronic condition that can impact individuals with brain 
        injury across the lifespan; and
          (2) not later than 2 years after the date of enactment of 
        this Act--
                  (A) submit to the Committee on Energy and Commerce of 
                the House of Representatives and the Committee on 
                Health, Education, Labor, and Pensions of the Senate a 
                report detailing the findings, conclusions, and 
                recommendations of the examination described in 
                paragraph (1); and
                  (B) make publicly available on the website of the 
                Centers for Disease Control and Prevention the report 
                described in subparagraph (A).

                          Purpose and Summary

    H.R. 7208 reauthorizes Traumatic Brain Injuries (TBI) 
programs at the Department of Health and Human Services (HHS). 
The programs reauthorized in this bill allocate resources for 
TBI prevention, improving access to TBI rehabilitation, and TBI 
patient advocacy systems. The bill reauthorizes the program for 
five fiscal years from 2025 through 2029.

                  Background and Need for Legislation

    In 2020 to 2021, there were approximately 214,110 TBI-
related hospitalizations and 69,473 deaths. People aged 75 
years and older had the highest numbers and rates of TBI-
related hospitalizations and deaths.\1\ The TBI Act was 
originally signed into law in 1996 and provides resources to 
states to help support individuals diagnosed and living with a 
TBI through three agencies at HHS. The Centers for Disease 
Control and Prevention (CDC) is responsible for conducting 
public information, education, and prevention activities for 
determining the incidence and prevalence of TBI in the United 
States. The National Institutes of Health (NIH) is responsible 
for conducting research on prevention, diagnosis, and treatment 
of TBI. The Administration for Community Living (ACL) is 
responsible for two grants programs to states to improve access 
to service delivery and support for the Protection and Advocacy 
System in each state. Recent data suggests that over 1.5 
million Americans annually survive a traumatic brain injury.\2\ 
TBIs usually occur when an outside force causes severe damage 
to the brain, this can impact a person's life in many ways, 
putting patients at increased risk for depression, falls, and 
permanent cognitive decline.\3\
---------------------------------------------------------------------------
    \1\Centers for Disease Control and Prevention, ``National Center 
for Health Statistics Mortality Data on CDC WONDER'', 2024. https://
wonder.cdc.gov/mcd.html.
    \2\Mayo Clinic, ``Traumatic Brain Injury Model Systems National 
Database'', 2024. https://www.mayo.edu/research/centers-programs/
traumatic-brain-injury-model-system/projects/nidilrr-tbi-national-
database.
    \3\Administration of Community Living, ``Traumatic Brain Injury'', 
2024. https://acl.gov/programs/post-injury-support/traumatic-brain-
injury-tbi.
---------------------------------------------------------------------------

                            Committee Action

    On February 14, 2024, the Subcommittee on Health held a 
hearing on H.R. 7208. The title of the hearing was 
``Legislative Proposals to Support Patients and Caregivers.'' 
The Subcommittee received testimony from:
           Andy Shih, PhD, Chief Science Officer, 
        Autism Speaks;
           Corey Feist, JD, MBA, Co-Founder and CEO, 
        Dr. Lorna Breen Heroes' Foundation;
           Joanne Pike, DrPH, President and CEO, 
        Alzheimer's Association;
           Gordon Tomaselli, MD, Former President, 
        American Heart Association; Marilyn and Stanley M. Katz 
        Dean, Emeritus and Professor of Medicine, Albert 
        Einstein College of Medicine; Adjunct Professor of 
        Medicine, Johns Hopkins University School of Medicine;
           Michelle Whitten, President, CEO, and Co-
        Founder, Global Down Syndrome Foundation;
           Randy Strozyk, President, American Ambulance 
        Association; and
           Christina Annunziata, MD, PhD, Senior Vice 
        President of Extramural Discovery Science, American 
        Cancer Society.
    On March 12, 2024, the Subcommittee on Health met in open 
markup session and forwarded H.R. 7208, as amended, to the full 
Committee by voice vote.
    On March 20, 2024, the full Committee on Energy and 
Commerce met in open markup session and ordered H.R. 7208, as 
amended, favorably reported to the House by a record vote of 44 
yeas and 0 nays.

                            Committee Votes

    Clause 3(b) of rule XIII requires the Committee to list the 
record votes on the motion to report legislation and amendments 
thereto. The following reflects the record votes taken during 
the Committee consideration:

    [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]

                 Oversight Findings and Recommendations

    Pursuant to clause 2(b)(1) of rule X and clause 3(c)(1) of 
rule XIII, the Committee held a hearing and made findings that 
are reflected in this report.

   New Budget Authority, Entitlement Authority, and Tax Expenditures

    Pursuant to clause 3(c)(2) of rule XIII, the Committee 
finds that H.R. 7208 would result in no new or increased budget 
authority, entitlement authority, or tax expenditures or 
revenues.

                  Congressional Budget Office Estimate

    Pursuant to clause 3(c)(3) of rule XIII, at the time this 
report was filed, the cost estimate prepared by the Director of 
the Congressional Budget Office pursuant to section 402 of the 
Congressional Budget Act of 1974 was not available.

                       Federal Mandates Statement

    The Committee adopts as its own the estimate of Federal 
mandates prepared by the Director of the Congressional 
BudgetOffice pursuant to section 423 of the Unfunded Mandates Reform 
Act.

         Statement of General Performance Goals and Objectives

    Pursuant to clause 3(c)(4) of rule XIII, the general 
performance goal or objective of this legislation is to 
continue support to states and other entities to help educate 
providers and patients on the incidence of TBIs and how they 
can be treated and prevented.

                    Duplication of Federal Programs

    Pursuant to clause 3(c)(5) of rule XIII, no provision of 
H.R. 7208 is known to be duplicative of another Federal 
program, including any program that was included in a report to 
Congress pursuant to section 21 of Public Law 111-139 or the 
most recent Catalog of Federal Domestic Assistance.

              Related Committee and Subcommittee Hearings

    Pursuant to clause 3(c)(6) of rule XIII, the following 
related hearing was used to develop or consider H.R. 7208:
           On February 14, 2024, the Subcommittee on 
        Health held a hearing on H.R. 7208. The title of the 
        hearing was ``Legislative Proposals to Support Patients 
        and Caregivers.'' The Subcommittee received testimony 
        from:
                   Andy Shih, PhD, Chief Science 
                Officer, Autism Speaks;
                   Corey Feist, JD, MBA, Co-Founder 
                and CEO, Dr. Lorna Breen Heroes' Foundation;
                   Joanne Pike, DrPH, President and 
                CEO, Alzheimer's Association;
                   Gordon Tomaselli, MD, Former 
                President, American Heart Association; Marilyn 
                and Stanley M. Katz Dean, Emeritus and 
                Professor of Medicine, Albert Einstein College 
                of Medicine; Adjunct Professor of Medicine, 
                Johns Hopkins University School of Medicine;
                   Michelle Whitten, President, 
                CEO, and Co-Founder, Global Down Syndrome 
                Foundation;
                   Randy Strozyk, President, 
                American Ambulance Association; and
                   Christina Annunziata, MD, PhD, 
                Senior Vice President of Extramural Discovery 
                Science, American Cancer Society.

                        Committee Cost Estimate

    Pursuant to clause 3(d)(1) of rule XIII, 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. At the time this report was 
filed, the estimate was not available.

       Earmark, Limited Tax Benefits, and Limited Tariff Benefits

    Pursuant to clause 9(e), 9(f), and 9(g) of rule XXI, the 
Committee finds that H.R. 7208 contains no earmarks, limited 
tax benefits, or limited tariff benefits.

                      Advisory Committee Statement

    No advisory committees within the meaning of section 5(b) 
of the Federal Advisory Committee Act were created by this 
legislation.

                  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 provides that the Act may be cited as the 
``Dennis John Beningo Traumatic Brain Injury Program 
Reauthorization Act of 2024''.

Section 2. National program for traumatic brain injury surveillance and 
        registries

    Section 2 repeals the reporting requirements that were 
established in 2008.

Section 3. Prevention and control of injuries

    Section 3 amends section 394A(b) of the Public Health 
Service Act to reauthorize activities related to the prevention 
and control of TBIs for five fiscal years, from fiscal year 
2025 through 2029.

Section 4. State grants for projects regarding traumatic brain injury

    Section 4 amends the definition of a TBI and makes 
technical and conforming changes. The section amends Title XII 
of the Public Health Service Act to reauthorize State grants 
for TBI projects for five fiscal years, from fiscal year 2025 
through 2029.

Section 5. State grants for protection and advocacy services

    Section 5 amends Title XII of the Public Health Service Act 
to reauthorize State grants that provide services to 
individuals with TBIs for five fiscal years, from fiscal year 
2025 through 2029.

Section 6. Report on designating brain injury as a chronic condition

    Section 6 provides for a report examining evidence for 
designating TBI as a chronic condition.

         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 italics, and existing law in which no 
change is proposed is shown in roman):

                       PUBLIC HEALTH SERVICE ACT




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

           *       *       *       *       *       *       *



Part J--Prevention and Control of Injuries

           *       *       *       *       *       *       *



national program for traumatic brain injury surveillance and registries

  Sec. 393C. (a) In General.--The Secretary, acting through the 
Director of the Centers for Disease Control and Prevention, may 
make grants to States or their designees to develop or operate 
the State's traumatic brain injury surveillance system or 
registry to determine the incidence and prevalence of traumatic 
brain injury and related disability, to ensure the uniformity 
of reporting under such system or registry, to link individuals 
with traumatic brain injury to services and supports, and to 
link such individuals with academic institutions to conduct 
applied research that will support the development of such 
surveillance systems and registries as may be necessary. A 
surveillance system or registry under this section shall 
provide for the collection of data concerning--
          (1) demographic information about each traumatic 
        brain injury;
          (2) information about the circumstances surrounding 
        the injury event associated with each traumatic brain 
        injury;
          (3) administrative information about the source of 
        the collected information, dates of hospitalization and 
        treatment, and the date of injury; and
          (4) information characterizing the clinical aspects 
        of the traumatic brain injury, including the severity 
        of the injury, outcomes of the injury, the types of 
        treatments received, and the types of services 
        utilized.
  [(b) Not later than 18 months after the date of enactment of 
the Traumatic Brain Injury Act of 2008, the Secretary, acting 
through the Director of the Centers for Disease Control and 
Prevention and the Director of the National Institutes of 
Health and in consultation with the Secretary of Defense and 
the Secretary of Veterans Affairs, shall submit to the relevant 
committees of Congress a report that contains the findings 
derived from an evaluation concerning activities and procedures 
that can be implemented by the Centers for Disease Control and 
Prevention to improve the collection and dissemination of 
compatible epidemiological studies on the incidence and 
prevalence of traumatic brain injury in individuals who were 
formerly in the military. The report shall include 
recommendations on the manner in which such agencies can 
further collaborate on the development and improvement of 
traumatic brain injury diagnostic tools and treatments.]
  (c) National Concussion Data Collection and Analysis.--The 
Secretary, acting through the Director of the Centers for 
Disease Control and Prevention, may implement concussion data 
collection and analysis to determine the prevalence and 
incidence of concussion.

           *       *       *       *       *       *       *


SEC. 394A. AUTHORIZATIONS OF APPROPRIATIONS.

  (a) In General.--For thepurpose of carrying out this part, 
there are authorized to be appropriated $50,000,000 for fiscal 
year 1994, and such sums as may be necessary for each of the 
fiscal years 1995 through 1998, and such sums as may be 
necessary for each of the fiscal years 2001 through 2005.
  (b) Traumatic Brain Injury.--To carry out sections 393B and 
393C, there are authorized to be appropriated $11,750,000 for 
each of [fiscal years 2020 through 2024] fiscal years 2025 
through 2029.

           *       *       *       *       *       *       *


TITLE XII--TRAUMA CARE

           *       *       *       *       *       *       *



Part E--Miscellaneous Programs

           *       *       *       *       *       *       *


SEC. 1252. STATE GRANTS FOR PROJECTS REGARDING TRAUMATIC BRAIN INJURY.

  (a) In General.--The Secretary, acting through the 
Administrator for the Administration for Community Living, may 
make grants to States and American Indian consortia for the 
purpose of carrying out projects to improve access to 
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 or American Indian 
        consortium involved agrees to establish an advisory 
        board within the appropriate health department of the 
        State or American Indian consortium or within another 
        department as designated by the chief executive officer 
        of the State or American Indian consortium.
          (2) Functions.--An advisory board established under 
        paragraph (1) shall advise and make recommendations to 
        the State or American Indian consortium on ways to 
        improve services coordination regarding traumatic brain 
        injury. Such advisory boards shall encourage citizen 
        participation through the establishment of public 
        hearings and other types of community outreach 
        programs. In developing recommendations under this 
        paragraph, such boards shall consult with Federal, 
        State, and local governmental agencies and with 
        citizens groups and other private entities.
          (3) Composition.--An advisory board established under 
        paragraph (1) shall be composed of--
                  (A) representatives of--
                          (i) the corresponding State or 
                        American Indian consortium agencies 
                        involved;
                          (ii) public and nonprofit private 
                        health related organizations;
                          (iii) other disability advisory or 
                        planning groups within the State or 
                        American Indian consortium;
                          (iv) members of an organization or 
                        foundation representing individuals 
                        with traumatic brain injury in that 
                        State or American Indian consortium; 
                        and
                          (v) injury control programs at the 
                        State or local level if such programs 
                        exist; and
                  (B) a substantial number of individuals with 
                traumatic brain injury, or the family members 
                of such individuals.
  (c) Matching Funds.--
          (1) In general.--With respect to the costs to be 
        incurred by a 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 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.] that 
        is--
                  (A) for fiscal years 2020 through 2024, not 
                less than $1 for each $2 of Federal funds 
                provided under the grant; and 
                  (B) for fiscal year 2025 and each succeeding 
                fiscal year, not less than $0.50 for each $2 of 
                Federal funds provided under the grant. 
          (2) Determination of amount contributed.--Non-Federal 
        contributions under paragraph (1) may be in cash or in 
        kind, fairly evaluated, including plant, equipment, or 
        services. Amounts provided by the Federal Government, 
        or services assisted or subsidized to any significant 
        extent by the Federal Government, may not be included 
        in determining the amount of such contributions.
  (d) Application for Grant.--The Secretary may make a grant 
under subsection (a) only if 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.
  [(e) Use of State and American Indian Consortium Grants.--
          [(1) Community services and supports.--A State or 
        American Indian consortium shall (directly or through 
        awards of contracts to nonprofit private entities) use 
        amounts received under a grant under this section for 
        the following:
                  [(A) To develop, change, or enhance 
                community-based service delivery systems that 
                include timely access to comprehensive 
                appropriate services and supports. Such service 
                and supports--
                          [(i) shall promote full participation 
                        by individuals with traumatic brain 
                        injury and their families in decision 
                        making regarding the services and 
                        supports; and
                          [(ii) shall be designed for children, 
                        youth, and adults with traumatic brain 
                        injury.
                  [(B) To focus on outreach to underserved and 
                inappropriately served individuals, such as 
                individuals in institutional settings, 
                individuals with low socioeconomic resources, 
                individuals in rural communities, and 
                individuals in culturally and linguistically 
                diverse communities.
                  [(C) To award contracts to nonprofit entities 
                for consumer or family service access training, 
                consumer support, peer mentoring, and parent to 
                parent programs.
                  [(D) To develop individual and family service 
                coordination or case management systems.
                  [(E) To support other needs identified by the 
                advisory board under subsection (b) for the 
                State or American Indian consortium involved.
          [(2) Best practices.--
                  [(A) In general.--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 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 or American 
        Indian consortium may use amounts received under a 
        grant under this section to--
                  [(A) educate consumers and families;
                  [(B) train professionals in public and 
                private sector financing (such as third party 
                payers, State agencies, community-based 
                providers, schools, and educators);
                  [(C) develop or improve case management or 
                service coordination systems;
                  [(D) develop best practices in areas such as 
                family or consumer support, return to work, 
                housing or supportive living personal 
                assistance services, assistive technology and 
                devices, behavioral health services, substance 
                abuse services, and traumatic brain injury 
                treatment and rehabilitation;
                  [(E) tailor existing State or American Indian 
                consortium systems to provide accommodations to 
                the needs of individuals with traumatic brain 
                injury (including systems administered by the 
                State or American Indian consortium departments 
                responsible for health, mental health, labor/
                employment, education, intellectual 
                disabilities or developmental disorders, 
                transportation, and correctional systems);
                  [(F) improve data sets coordinated across 
                systems and other needs identified by a State 
                or American Indian consortium plan supported by 
                its advisory council; and
                  [(G) develop capacity within targeted 
                communities.]
  [(f)] (e) Coordination of Activities.--The Secretary shall 
ensure that activities under this section are coordinated as 
appropriate with other Federal agencies that carry out 
activities regarding traumatic brain injury.
  [(g)] (f) Report.--Not less than biennially, the Secretary 
shall submit to the Committee on 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.
  [(h)] (g) Definitions.--For purposes of this section:
          (1) The terms ``American Indian consortium'' and 
        ``State'' have the meanings given to those terms in 
        section 1253.
          [(2) The term ``traumatic brain injury'' means an 
        acquired injury to the brain. Such term does not 
        include brain dysfunction caused by congenital or 
        degenerative disorders, nor birth trauma, but may 
        include brain injuries caused by anoxia due to trauma. 
        The Secretary may revise the definition of such term as 
        the Secretary determines necessary, after consultation 
        with States and other appropriate public or nonprofit 
        private entities.]
          (2)(A) The term ``traumatic brain injury'' means an 
        acquired injury to the brain.
          (B) Such term--
                  (i) does not include brain dysfunction caused 
                by congenital or degenerative disorders, nor 
                birth trauma; and
                  (ii) may include--
                          (I) brain injuries caused by anoxia 
                        due to trauma; and
                          (II) damage to the brain from an 
                        internal or external source that 
                        results in toxicity, surgery, or 
                        vascular disorders not associated with 
                        aging.
          (C) 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)] (h) Authorization of Appropriations.--For the purpose 
of carrying out this section, there are authorized to be 
appropriated $7,321,000 for each of [fiscal years 2020 through 
2024] fiscal years 2025 through 2029.

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

  (a) In General.--The Secretary, acting through the 
Administrator for the Administration for Community Living, 
shall make grants to protection and advocacy systems for the 
purpose of enabling such systems to provide services to 
individuals with traumatic brain injury.
  (b) Services Provided.--Services provided under this section 
may include the provision of--
          (1) information, referrals, and advice;
          (2) individual and family advocacy;
          (3) legal representation; and
          (4) specific assistance in self-advocacy.
  (c) Application.--To be eligible to receive a grant under 
this section, a protection and advocacy system shall submit an 
application to the Secretary at such time, in such form and 
manner, and accompanied by such information and assurances as 
the Secretary may require.
  (d) Appropriations Less Than $2,700,000.--
          (1) In general.--With respect to any fiscal year in 
        which the amount appropriated under subsection (l) to 
        carry out this section is less than $2,700,000, the 
        Secretary 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) Amount.--The amount of each grant provided under 
        paragraph (1) shall be determined as set forth in 
        paragraphs (2) and (3) of subsection (e).
  (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 (l) to 
        carry out this section is $2,700,000 or more, the 
        Secretary 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 (l) as 
        the population of the State in which the grantee is 
        located bears to the population of all States.
          (3) Minimums.--Subject to the availability of 
        appropriations, the amount of a grant a protection and 
        advocacy system under paragraph (1) for a fiscal year 
        shall--
                  (A) in the case of a protection and advocacy 
                system located in American Samoa, Guam, the 
                United States Virgin Islands, or the 
                Commonwealth of the Northern Mariana Islands, 
                and the protection and advocacy system serving 
                the American Indian consortium, not be less 
                than $20,000; and
                  (B) in the case of a protection and advocacy 
                system in a State not described in subparagraph 
                (A), not be less than $50,000.
          (4) Inflation adjustment.--For each fiscal year in 
        which the total amount appropriated under 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 Secretary 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 (l) to carry out this section between 
        the preceding fiscal year and the fiscal year involved.
  (f) Carryover.--Any amount paid to a protection and advocacy 
system that serves a State or the American Indian consortium 
for a fiscal year under this section that remains unobligated 
at the end of such fiscal year shall remain available to such 
system for obligation during the next fiscal year for the 
purposes for which such amount was originally provided.
  (g) Direct Payment.--Notwithstanding any other provision of 
law, each fiscal year not later than October 1, the Secretary 
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) Reporting.--
          (1) Reports by systems.--Each protection and advocacy 
        system that receives a payment under this section shall 
        submit an annual report to the Secretary concerning the 
        services provided to individuals with traumatic brain 
        injury by such system.
          (2) Report by secretary.--Not later than 1 year after 
        the date of enactment of the Traumatic Brain Injury 
        Reauthorization Act of 2014, the Secretary shall 
        prepare and submit to the appropriate committees of 
        Congress a report describing the services and 
        activities carried out under this section during the 
        period for which the report is being prepared.
  (i) Data Collection.--The Secretary shall facilitate 
agreements to coordinate the collection of data by agencies 
within the Department of Health and Human Services 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 Secretary shall use 2 percent of such 
        amount to make a grant to an eligible national 
        association for providing for training and technical 
        assistance to protection and advocacy systems.
          (2) Definition.--In this subsection, the term 
        ``eligible national association'' means a national 
        association with demonstrated experience in providing 
        training and technical assistance to protection and 
        advocacy systems.
  (k) System Authority.--In providing services under this 
section, a protection and advocacy system shall have the same 
authorities, including access to records, as such system would 
have for purposes of providing services under subtitle C of 
title I of the Developmental Disabilities Assistance and Bill 
of Rights Act of 2000 (42 U.S.C. 15041 et seq.).
  (l) Authorization of Appropriations.--There are authorized to 
be appropriated to carry out this section $4,000,000 for each 
of [fiscal years 2020 through 2024] fiscal years 2025 through 
2029.
  (m) Definitions.--In this section:
          (1) American indian consortium.--The term ``American 
        Indian consortium'' means a consortium established 
        under subtitle C of title I of the Developmental 
        Disabilities Assistance and Bill of Rights Act of 2000 
        (42 U.S.C. 15041 et seq.).
          (2) Protection and advocacy system.--The term 
        ``protection and advocacy system'' means a protection 
        and advocacy system established under subtitle C of 
        title I of the Developmental Disabilities Assistance 
        and Bill of Rights Act of 2000 (42 U.S.C. 15041 et 
        seq.).
          (3) State.--The term ``State'', unless otherwise 
        specified, means the several States of the United 
        States, the District of Columbia, the Commonwealth of 
        Puerto Rico, the United States Virgin Islands, Guam, 
        American Samoa, and the Commonwealth of the Northern 
        Mariana Islands.

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