[110th Congress Public Law 23]
[From the U.S. Government Printing Office]


[DOCID: f:publ023.110]

[[Page 89]]

        TRAUMA CARE SYSTEMS PLANNING AND DEVELOPMENT ACT OF 2007

[[Page 121 STAT. 90]]

Public Law 110-23
110th Congress

                                 An Act


 
  To amend the Public Health Service Act to add requirements regarding 
   trauma care, and for other purposes. <<NOTE: May 3, 2007 -  [H.R. 
                                 727]>> 

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress <<NOTE: Trauma Care Systems 
Planning and Development Act of 2007. 42 USC 201 note.>> assembled,
SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Trauma Care Systems Planning and 
Development Act of 2007''.
SEC. 2. ESTABLISHMENT.

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

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

    ``(b) Grants, Cooperative Agreements, and Contracts.--The Secretary 
may make grants, and enter into cooperative agreements and contracts, 
for the purpose of carrying out subsection (a).''.
SEC. 3. CLEARINGHOUSE ON TRAUMA CARE AND EMERGENCY MEDICAL 
                    SERVICES.

    The Public Health Service Act (42 U.S.C. 201 et seq.) is amended--
            (1) by striking section <<NOTE: 42 USC 300d-2.>> 1202; and
            (2) by redesignating section <<NOTE: 42 USC 300d-3.>> 1203 
        as section 1202.

[[Page 121 STAT. 91]]

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

    Section 1202 of the Public Health Service Act, as redesignated by 
section 3(2), is amended to read as follows:
``SEC. 1202. <<NOTE: 42 USC 300d-3.>> ESTABLISHMENT OF PROGRAMS 
                          FOR IMPROVING TRAUMA CARE IN RURAL 
                          AREAS.

    ``(a) In General.--The Secretary may make grants to public and 
nonprofit private entities for the purpose of carrying out research and 
demonstration projects with respect to improving the availability and 
quality of emergency medical services in rural areas--
            ``(1) by developing innovative uses of communications 
        technologies and the use of new communications technology;
            ``(2) by developing model curricula, such as advanced trauma 
        life support, for training emergency medical services personnel, 
        including first responders, emergency medical technicians, 
        emergency nurses and physicians, and para- medics--
                    ``(A) in the assessment, stabilization, treatment, 
                preparation for transport, and resuscitation of 
                seriously injured patients, with special attention to 
                problems that arise during long transports and to 
                methods of minimizing delays in transport to the 
                appropriate facility; and
                    ``(B) in the management of the operation of the 
                emergency medical services system;
            ``(3) by making training for original certification, and 
        continuing education, in the provision and management of 
        emergency medical services more accessible to emergency medical 
        personnel in rural areas through telecommunications, home 
        studies, providing teachers and training at locations accessible 
        to such personnel, and other methods;
            ``(4) by developing innovative protocols and agreements to 
        increase access to prehospital care and equipment necessary for 
        the transportation of seriously injured patients to the 
        appropriate facilities;
            ``(5) by evaluating the effectiveness of protocols with 
        respect to emergency medical services and systems; and
            ``(6) by increasing communication and coordination with 
        State trauma systems.

    ``(b) Special Consideration for Certain Rural Areas.--In making 
grants under subsection (a), the Secretary shall give special 
consideration to any applicant for the grant that will provide services 
under the grant in any rural area identified by a State under section 
1214(d)(1).
    ``(c) Requirement of Application.--The Secretary may not make a 
grant under subsection (a) unless an application for the grant is 
submitted to the Secretary and the application is in such form, is made 
in such manner, and contains such agreements, assurances, and 
information as the Secretary determines to be necessary to carry out 
this section.''.
SEC. 5. COMPETITIVE GRANTS.

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

[[Page 121 STAT. 92]]

``SEC. 1203. <<NOTE: 42 USC 300d-5.>> COMPETITIVE GRANTS FOR THE 
                          IMPROVEMENT OF TRAUMA CARE.

    ``(a) In General.--The Secretary, acting through the Administrator 
of the Health Resources and Services Administration, may make grants to 
States, political subdivisions, or consortia of States or political 
subdivisions for the purpose of improving access to and enhancing the 
development of trauma care systems.
    ``(b) Use of Funds.--The Secretary may make a grant under this 
section only if the applicant agrees to use the grant--
            ``(1) to integrate and broaden the reach of a trauma care 
        system, such as by developing innovative protocols to increase 
        access to prehospital care;
            ``(2) to strengthen, develop, and improve an existing trauma 
        care system;
            ``(3) to expand communications between the trauma care 
        system and emergency medical services through improved equipment 
        or a telemedicine system;
            ``(4) to improve data collection and retention; or
            ``(5) to increase education, training, and technical 
        assistance opportunities, such as training and continuing 
        education in the management of emergency medical services 
        accessible to emergency medical personnel in rural areas through 
        telehealth, home studies, and other methods.

    ``(c) Preference.--In selecting among States, political 
subdivisions, and consortia of States or political subdivisions for 
purposes of making grants under this section, the Secretary shall give 
preference to applicants that--
            ``(1) have developed a process, using national standards, 
        for designating trauma centers;
            ``(2) recognize protocols for the delivery of seriously 
        injured patients to trauma centers;
            ``(3) implement a process for evaluating the performance of 
        the trauma system; and
            ``(4) agree to participate in information systems described 
        in section 1202 by collecting, providing, and sharing 
        information.

    ``(d) Priority.--In making grants under this section, the Secretary 
shall give priority to applicants that will use the grants to focus on 
improving access to trauma care systems.
    ``(e) Special Consideration.--In awarding grants under this section, 
the Secretary shall give special consideration to projects that 
demonstrate strong State or local support, including availability of 
non-Federal contributions.''.
SEC. 6. REQUIREMENT OF MATCHING FUNDS FOR FISCAL YEARS SUBSEQUENT 
                    TO FIRST FISCAL YEAR OF PAYMENTS.

    Section 1212 of the Public Health Service Act (42 U.S.C. 300d-12) is 
amended to read as follows:
``SEC. 1212. REQUIREMENT OF MATCHING FUNDS FOR FISCAL YEARS 
                          SUBSEQUENT TO FIRST FISCAL YEAR OF 
                          PAYMENTS.

    ``(a) Non-Federal Contributions.--
            ``(1) In general.--The Secretary may not make payments under 
        section 1211(a) unless the State involved agrees, with respect 
        to the costs described in paragraph (2), to make available non-
        Federal contributions (in cash or in kind under subsection 
        (b)(1)) toward such costs in an amount that--

[[Page 121 STAT. 93]]

                    ``(A) for the second and third fiscal years of such 
                payments to the State, is not less than $1 for each $1 
                of Federal funds provided in such payments for such 
                fiscal years; and
                    ``(B) for the fourth and subsequent fiscal years of 
                such payments to the State, is not less than $2 for each 
                $1 of Federal funds provided in such payments for such 
                fiscal years.
            ``(2) Program costs.--The costs referred to in paragraph (1) 
        are--
                    ``(A) the costs to be incurred by the State in 
                carrying out the purpose described in section 1211(b); 
                or
                    ``(B) the costs of improving the quality and 
                availability of emergency medical services in rural 
                areas of the State.
            ``(3) Initial year of payments.--The Secretary may not 
        require a State to make non-Federal contributions as a condition 
        of receiving payments under section 1211(a) for the first fiscal 
        year of such payments to the State.

    ``(b) Determination of Amount of Non-Federal Contribution.--With 
respect to compliance with subsection (a) as a condition of receiving 
payments under section 1211(a)--
            ``(1) a State may make the non-Federal contributions 
        required in such subsection in cash or in kind, fairly 
        evaluated, including plant, equipment, or services; and
            ``(2) the Secretary may not, in making a determination of 
        the amount of non-Federal contributions, include amounts 
        provided by the Federal Government or services assisted or 
        subsidized to any significant extent by the Federal 
        Government.''.
SEC. 7. REQUIREMENTS WITH RESPECT TO CARRYING OUT PURPOSE OF 
                    ALLOTMENTS.

    Section 1213 of the Public Health Service Act (42 U.S.C. 300d-13) is 
amended to read as follows:
``SEC. 1213. REQUIREMENTS WITH RESPECT TO CARRYING OUT PURPOSE OF 
                          ALLOTMENTS.

    ``(a) Trauma Care Modifications to State Plan for Emergency Medical 
Services.--With respect to the trauma care component of a State plan for 
the provision of emergency medical services, the modifications referred 
to in section 1211(b) are such modifications to the State plan as may be 
necessary for the State involved to ensure that the plan provides for 
access to the highest possible quality of trauma care, and that the 
plan--
            ``(1) specifies that the modifications required pursuant to 
        paragraphs (2) through (11) will be implemented by the principal 
        State agency with respect to emergency medical services or by 
        the designee of such agency;
            ``(2) specifies a public or private entity that will 
        designate trauma care regions and trauma centers in the State;
            ``(3) subject to subsection (b), contains national standards 
        and requirements of the American College of Surgeons or another 
        appropriate entity for the designation of level I and level II 
        trauma centers, and in the case of rural areas level III trauma 
        centers (including trauma centers with specified capabilities 
        and expertise in the care of pediatric trauma patients), by such 
        entity, including standards and requirements for--

[[Page 121 STAT. 94]]

                    ``(A) the number and types of trauma patients for 
                whom such centers must provide care in order to ensure 
                that such centers will have sufficient experience and 
                expertise to be able to provide quality care for victims 
                of injury;
                    ``(B) the resources and equipment needed by such 
                centers; and
                    ``(C) the availability of rehabilitation services 
                for trauma patients;
            ``(4) contains standards and requirements for the 
        implementation of regional trauma care systems, including 
        standards and guidelines (consistent with the provisions of 
        section 1867 of the Social Security Act) for medically directed 
        triage and transportation of trauma patients (including patients 
        injured in rural areas) prior to care in designated trauma 
        centers;
            ``(5) subject to subsection (b), contains national standards 
        and requirements, including those of the American Academy of 
        Pediatrics and the American College of Emergency Physicians, for 
        medically directed triage and transport of severely injured 
        children to designated trauma centers with specified 
        capabilities and expertise in the care of pediatric trauma 
        patients;
            ``(6) utilizes a program with procedures for the evaluation 
        of designated trauma centers (including trauma centers described 
        in paragraph (5)) and trauma care systems;
            ``(7) <<NOTE: Records.>> provides for the establishment and 
        collection of data in accordance with data collection 
        requirements developed in consultation with surgical, medical, 
        and nursing specialty groups, State and local emergency medical 
        services directors, and other trained professionals in trauma 
        care, from each designated trauma center in the State of a 
        central data reporting and analysis system--
                    ``(A) to identify the number of severely injured 
                trauma patients and the number of deaths from trauma 
                within trauma care systems in the State;
                    ``(B) to identify the cause of the injury and any 
                factors contributing to the injury;
                    ``(C) to identify the nature and severity of the 
                injury;
                    ``(D) to monitor trauma patient care (including 
                prehospital care) in each designated trauma center 
                within regional trauma care systems in the State 
                (including relevant emergency-department discharges and 
                rehabilitation information) for the purpose of 
                evaluating the diagnosis, treatment, and treatment 
                outcome of such trauma patients;
                    ``(E) to identify the total amount of uncompensated 
                trauma care expenditures for each fiscal year by each 
                designated trauma center in the State; and
                    ``(F) to identify patients transferred within a 
                regional trauma system, including reasons for such 
                transfer and the outcomes of such patients;
            ``(8) provides for the use of procedures by paramedics and 
        emergency medical technicians to assess the severity of the 
        injuries incurred by trauma patients;
            ``(9) provides for appropriate transportation and transfer 
        policies to ensure the delivery of patients to designated trauma 
        centers and other facilities within and outside of the 
        jurisdiction

[[Page 121 STAT. 95]]

        of such system, including policies to ensure that only 
        individuals appropriately identified as trauma patients are 
        transferred to designated trauma centers, and to provide 
        periodic reviews of the transfers and the auditing of such 
        transfers that are determined to be appropriate;
            ``(10) conducts public education activities concerning 
        injury prevention and obtaining access to trauma care;
            ``(11) coordinates planning for trauma systems with State 
        disaster emergency planning and bioterrorism hospital 
        preparedness planning; and
            ``(12) with respect to the requirements established in this 
        subsection, provides for coordination and cooperation between 
        the State and any other State with which the State shares any 
        standard metropolitan statistical area.

    ``(b) Certain Standards With Respect to Trauma Care Centers and 
Systems.--
            ``(1) In general.--The Secretary may not make payments under 
        section 1211(a) for a fiscal year unless the State involved 
        agrees that, in carrying out paragraphs (3) through (5) of 
        subsection (a), the State will adopt standards for the 
        designation of trauma centers, and for triage, transfer, and 
        transportation policies, and that the State will, in adopting 
        such standards--
                    ``(A) take into account national standards that 
                outline resources for optimal care of injured patients;
                    ``(B) consult with medical, surgical, and nursing 
                speciality groups, hospital associations, emergency 
                medical services State and local directors, concerned 
                advocates, and other interested parties;
                    ``(C) <<NOTE: Notice.>> conduct hearings on the 
                proposed standards after providing adequate notice to 
                the public concerning such hearing; and
                    ``(D) beginning in fiscal year 2008, take into 
                account the model plan described in subsection (c).
            ``(2) Quality of trauma care.--The highest quality of trauma 
        care shall be the primary goal of State standards adopted under 
        this subsection.
            ``(3) Approval by the secretary.--The Secretary may not make 
        payments under section 1211(a) to a State if the Secretary 
        determines that--
                    ``(A) in the case of payments for fiscal year 2008 
                and subsequent fiscal years, the State has not taken 
                into account national standards, including those of the 
                American College of Surgeons, the American College of 
                Emergency Physicians, and the American Academy of 
                Pediatrics, in adopting standards under this subsection; 
                or
                    ``(B) in the case of payments for fiscal year 2008 
                and subsequent fiscal years, the State has not, in 
                adopting such standards, taken into account the model 
                plan developed under subsection (c).

    ``(c) Model Trauma Care Plan.--
            ``(1) In general.--Not <<NOTE: Deadline.>> later than 1 year 
        after the date of the enactment of the Trauma Care Systems 
        Planning and Development Act of 2007, the Secretary shall update 
        the model plan for the designation of trauma centers and for 
        triage, transfer, and transportation policies that may be 
        adopted for guidance by the State. Such plan shall--

[[Page 121 STAT. 96]]

                    ``(A) take into account national standards, 
                including those of the American College of Surgeons, 
                American College of Emergency Physicians, and the 
                American Academy of Pediatrics;
                    ``(B) take into account existing State plans;
                    ``(C) be developed in consultation with medical, 
                surgical, and nursing speciality groups, hospital 
                associations, emergency medical services State directors 
                and associations, and other interested parties; and
                    ``(D) include standards for the designation of rural 
                health facilities and hospitals best able to receive, 
                stabilize, and transfer trauma patients to the nearest 
                appropriate designated trauma center, and for triage, 
                transfer, and transportation policies as they relate to 
                rural areas.
            ``(2) Applicability.--Standards described in paragraph 
        (1)(D) shall be applicable to all rural areas in the State, 
        including both non-metropolitan areas and frontier areas that 
        have populations of less than 6,000 per square mile.

    ``(d) Rule of Construction With Respect to Number of Designated 
Trauma Centers.--With respect to compliance with subsection (a) as a 
condition of the receipt of a grant under section 1211(a), such 
subsection may not be construed to specify the number of trauma care 
centers designated pursuant to such subsection.''.
SEC. 8. REQUIREMENT OF SUBMISSION TO SECRETARY OF TRAUMA PLAN AND 
                    CERTAIN INFORMATION.

    Section 1214 of the Public Health Service Act (42 U.S.C. 300d-14) is 
amended to read as follows:
``SEC. 1214. REQUIREMENT OF SUBMISSION TO SECRETARY OF TRAUMA PLAN 
                          AND CERTAIN INFORMATION.

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

[[Page 121 STAT. 97]]

            ``(2) the State submits to the Secretary a list of rural 
        areas identified pursuant to paragraph (1) or, if there are no 
        such areas, a statement that there are no such areas.''.
SEC. 9. RESTRICTIONS ON USE OF PAYMENTS.

    Section 1215 of the Public Health Service Act (42 U.S.C. 300d-15) is 
amended to read as follows:
``SEC. 1215. RESTRICTIONS ON USE OF PAYMENTS.

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

    ``(b) Waiver.--The Secretary may waive a restriction under 
subsection (a) only if the Secretary determines that the activities 
outlined by the State plan submitted under section 1214(a) by the State 
involved cannot otherwise be carried out.''.
SEC. 10. REQUIREMENTS OF REPORTS BY STATES.

    The Public Health Service Act (42 U.S.C. 201 et seq.) is amended by 
striking <<NOTE: 42 USC 300d-16.>> section 1216.
SEC. 11. REPORT BY SECRETARY.

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

    ``Not later than October 1, 2008, the Secretary shall report to the 
appropriate committees of Congress on the activities of the States 
carried out pursuant to section 1211. Such report shall include an 
assessment of the extent to which Federal and State efforts to develop 
systems of trauma care and to designate trauma centers have reduced the 
incidence of mortality, and the incidence of permanent disability, 
resulting from trauma. Such report may include any recommendations of 
the Secretary for appropriate administrative and legislative initiatives 
with respect to trauma care.''.
SEC. 12. FUNDING.

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

    ``(a) Authorization of Appropriations.--For the purpose of carrying 
out parts A and B, subject to subsections (b) and (c), there are 
authorized to be appropriated $12,000,000 for fiscal year

[[Page 121 STAT. 98]]

2008, $10,000,000 for fiscal year 2009, and $8,000,000 for each of the 
fiscal years 2010 through 2012.
    ``(b) Reservation of Funds.--If the amount appropriated under 
subsection (a) for a fiscal year is equal to or less than $1,000,000, 
such appropriation is available only for the purpose of carrying out 
part A. If the amount so appropriated is greater than $1,000,000, 50 
percent of such appropriation shall be made available for the purpose of 
carrying out part A and 50 percent shall be made available for the 
purpose of carrying out part B.
    ``(c) Allocation of Part A Funds.--Of the amounts appropriated under 
subsection (a) for a fiscal year to carry out part A--
            ``(1) 10 percent of such amounts for such year shall be 
        allocated for administrative purposes; and
            ``(2) 10 percent of such amounts for such year shall be 
        allocated for the purpose of carrying out section 1202.''.
SEC. 13. RESIDENCY TRAINING PROGRAMS IN EMERGENCY MEDICINE.

    Section 1251 of the Public Health Service Act (42 U.S.C. 300d-51) is 
amended to read as follows:
``SEC. 1251. RESIDENCY TRAINING PROGRAMS IN EMERGENCY MEDICINE.

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

[[Page 121 STAT. 99]]

SEC. 14. STATE GRANTS FOR CERTAIN PROJECTS.

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

    Approved May 3, 2007.

LEGISLATIVE HISTORY--H.R. 727:
---------------------------------------------------------------------------

HOUSE REPORTS: No. 110-77 (Comm. on Energy and Commerce).
CONGRESSIONAL RECORD, Vol. 153 (2007):
            Mar. 27, considered and passed House.
            Mar. 29, considered and passed Senate.

                                  <all>