PUBLIC LAW 110–23—MAY 3, 2007

TRAUMA CARE SYSTEMS PLANNING AND

DEVELOPMENT ACT OF 2007

121 STAT. 90 PUBLIC LAW 110–23—MAY 3, 2007

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.

Be it enacted by the Senate and House of Representatives of

the United States of America in Congress 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 1202; and

42 USC 300d–3. (2) by redesignating section 1203 as section 1202.

42 USC 300d–2.

Trauma Care

Systems

Planning and

Development Act

of 2007.

42 USC 201 note.

May 3, 2007

[H.R. 727]

PUBLIC LAW 110–23—MAY 3, 2007 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. ESTABLISHMENT OF PROGRAMS FOR IMPROVING TRAUMA

CARE IN RURAL AREAS.

‘‘(a) IN GENERAL.—The Secretary may make grants to public

and nonprofit private entities for the purpose of carrying out

research and demonstration projects with respect to improving the

availability and quality of emergency medical services in rural

areas—

‘‘(1) by developing innovative uses of communications technologies and the use of new communications technology;

‘‘(2) by developing model curricula, such as advanced

trauma life support, for training emergency medical services

personnel, including first responders, emergency medical

technicians, emergency nurses and physicians, and paramedics—

‘‘(A) in the assessment, stabilization, treatment,

preparation for transport, and resuscitation of seriously

injured patients, with special attention to problems that

arise during long transports and to methods of minimizing

delays in transport to the appropriate facility; and

‘‘(B) in the management of the operation of the emergency medical services system;

‘‘(3) by making training for original certification, and continuing education, in the provision and management of emergency medical services more accessible to emergency medical

personnel in rural areas through telecommunications, home

studies, providing teachers and training at locations accessible

to such personnel, and other methods;

‘‘(4) by developing innovative protocols and agreements to

increase access to prehospital care and equipment necessary

for the transportation of seriously injured patients to the appropriate facilities;

‘‘(5) by evaluating the effectiveness of protocols with respect

to emergency medical services and systems; and

‘‘(6) by increasing communication and coordination with

State trauma systems.

‘‘(b) SPECIAL CONSIDERATION FOR CERTAIN RURAL AREAS.—In

making grants under subsection (a), the Secretary shall give special

consideration to any applicant for the grant that will provide services under the grant in any rural area identified by a State under

section 1214(d)(1).

‘‘(c) REQUIREMENT OF APPLICATION.—The Secretary may not

make a grant under subsection (a) unless an application for the

grant is submitted to the Secretary and the application is in such

form, is made in such manner, and contains such agreements,

assurances, and information as the Secretary determines to be

necessary to carry out this section.’’.

SEC. 5. COMPETITIVE GRANTS.

Part A of title XII of the Public Health Service Act, as amended

by section 3, is amended by adding at the end the following:

42 USC 300d–3.

121 STAT. 92 PUBLIC LAW 110–23—MAY 3, 2007

‘‘SEC. 1203. COMPETITIVE GRANTS FOR THE IMPROVEMENT OF

TRAUMA CARE.

‘‘(a) IN GENERAL.—The Secretary, acting through the Administrator of the Health Resources and Services Administration, may

make grants to States, political subdivisions, or consortia of States

or political subdivisions for the purpose of improving access to

and enhancing the development of trauma care systems.

‘‘(b) USE OF FUNDS.—The Secretary may make a grant under

this section only if the applicant agrees to use the grant—

‘‘(1) to integrate and broaden the reach of a trauma care

system, such as by developing innovative protocols to increase

access to prehospital care;

‘‘(2) to strengthen, develop, and improve an existing trauma

care system;

‘‘(3) to expand communications between the trauma care

system and emergency medical services through improved

equipment or a telemedicine system;

‘‘(4) to improve data collection and retention; or

‘‘(5) to increase education, training, and technical assistance

opportunities, such as training and continuing education in

the management of emergency medical services accessible to

emergency medical personnel in rural areas through telehealth,

home studies, and other methods.

‘‘(c) PREFERENCE.—In selecting among States, political subdivisions, and consortia of States or political subdivisions for purposes

of making grants under this section, the Secretary shall give preference to applicants that—

‘‘(1) have developed a process, using national standards,

for designating trauma centers;

‘‘(2) recognize protocols for the delivery of seriously injured

patients to trauma centers;

‘‘(3) implement a process for evaluating the performance

of the trauma system; and

‘‘(4) agree to participate in information systems described

in section 1202 by collecting, providing, and sharing information.

‘‘(d) PRIORITY.—In making grants under this section, the Secretary shall give priority to applicants that will use the grants

to focus on improving access to trauma care systems.

‘‘(e) SPECIAL CONSIDERATION.—In awarding grants under this

section, the Secretary shall give special consideration to projects

that demonstrate strong State or local support, including availability of non-Federal contributions.’’.

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

Section 1212 of the Public Health Service Act (42 U.S.C. 300d–

12) is amended to read as follows:

‘‘SEC. 1212. REQUIREMENT OF MATCHING FUNDS FOR FISCAL YEARS

SUBSEQUENT TO FIRST FISCAL YEAR OF PAYMENTS.

‘‘(a) NON-FEDERAL CONTRIBUTIONS.—

‘‘(1) IN GENERAL.—The Secretary may not make payments

under section 1211(a) unless the State involved agrees, with

respect to the costs described in paragraph (2), to make available non-Federal contributions (in cash or in kind under subsection (b)(1)) toward such costs in an amount that—

42 USC 300d–5.

PUBLIC LAW 110–23—MAY 3, 2007 121 STAT. 93

‘‘(A) for the second and third fiscal years of such pay- ments 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 CONTRIBU- TION.—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 EMER- GENCY 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—

121 STAT. 94 PUBLIC LAW 110–23—MAY 3, 2007

‘‘(A) the number and types of trauma patients for whom

such centers must provide care in order to ensure that

such centers will have sufficient experience and expertise

to be able to provide quality care for victims of injury;

‘‘(B) the resources and equipment needed by such centers; and

‘‘(C) the availability of rehabilitation services for

trauma patients;

‘‘(4) contains standards and requirements for the

implementation of regional trauma care systems, including

standards and guidelines (consistent with the provisions of

section 1867 of the Social Security Act) for medically directed

triage and transportation of trauma patients (including patients

injured in rural areas) prior to care in designated trauma

centers;

‘‘(5) subject to subsection (b), contains national standards

and requirements, including those of the American Academy

of Pediatrics and the American College of Emergency Physicians, for medically directed triage and transport of severely

injured children to designated trauma centers with specified

capabilities and expertise in the care of pediatric trauma

patients;

‘‘(6) utilizes a program with procedures for the evaluation

of designated trauma centers (including trauma centers

described in paragraph (5)) and trauma care systems;

‘‘(7) provides for the establishment and collection of data

in accordance with data collection requirements developed in

consultation with surgical, medical, and nursing specialty

groups, State and local emergency medical services directors,

and other trained professionals in trauma care, from each designated trauma center in the State of a central data reporting

and analysis system—

‘‘(A) to identify the number of severely injured trauma

patients and the number of deaths from trauma within

trauma care systems in the State;

‘‘(B) to identify the cause of the injury and any factors

contributing to the injury;

‘‘(C) to identify the nature and severity of the injury;

‘‘(D) to monitor trauma patient care (including

prehospital care) in each designated trauma center within

regional trauma care systems in the State (including relevant emergency-department discharges and rehabilitation

information) for the purpose of evaluating the diagnosis,

treatment, and treatment outcome of such trauma patients;

‘‘(E) to identify the total amount of uncompensated

trauma care expenditures for each fiscal year by each designated trauma center in the State; and

‘‘(F) to identify patients transferred within a regional

trauma system, including reasons for such transfer and

the outcomes of such patients;

‘‘(8) provides for the use of procedures by paramedics and

emergency medical technicians to assess the severity of the

injuries incurred by trauma patients;

‘‘(9) provides for appropriate transportation and transfer

policies to ensure the delivery of patients to designated trauma

centers and other facilities within and outside of the jurisdiction

Records.

PUBLIC LAW 110–23—MAY 3, 2007 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) conduct hearings on the proposed standards after

providing adequate notice to the public concerning such

hearing; and

‘‘(D) beginning in fiscal year 2008, take into account

the model plan described in subsection (c).

‘‘(2) QUALITY OF TRAUMA CARE.—The highest quality of

trauma care shall be the primary goal of State standards

adopted under this subsection.

‘‘(3) APPROVAL BY THE SECRETARY.—The Secretary may not

make payments under section 1211(a) to a State if the Secretary

determines that—

‘‘(A) in the case of payments for fiscal year 2008 and

subsequent fiscal years, the State has not taken into

account national standards, including those of the American College of Surgeons, the American College of Emergency Physicians, and the American Academy of Pediatrics,

in adopting standards under this subsection; or

‘‘(B) in the case of payments for fiscal year 2008 and

subsequent fiscal years, the State has not, in adopting

such standards, taken into account the model plan developed under subsection (c).

‘‘(c) MODEL TRAUMA CARE PLAN.—

‘‘(1) IN GENERAL.—Not later than 1 year after the date

of the enactment of the Trauma Care Systems Planning and

Development Act of 2007, the Secretary shall update the model

plan for the designation of trauma centers and for triage,

transfer, and transportation policies that may be adopted for

guidance by the State. Such plan shall—

Deadline.

Notice.

121 STAT. 96 PUBLIC LAW 110–23—MAY 3, 2007

‘‘(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

PUBLIC LAW 110–23—MAY 3, 2007 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 nonFederal funds as a condition for the receipt of Federal funds;

or

‘‘(5) to provide financial assistance to any entity other

than a public or nonprofit private entity.

‘‘(b) WAIVER.—The Secretary may waive a restriction under

subsection (a) only if the Secretary determines that the activities

outlined by the State plan submitted under section 1214(a) by

the State involved cannot otherwise be carried out.’’.

SEC. 10. REQUIREMENTS OF REPORTS BY STATES.

The Public Health Service Act (42 U.S.C. 201 et seq.) is

amended by striking section 1216.

SEC. 11. REPORT BY SECRETARY.

Section 1222 of the Public Health Service Act (42 U.S.C. 300d–

22) is amended to read as follows:

‘‘SEC. 1222. REPORT BY SECRETARY.

‘‘Not later than October 1, 2008, the Secretary shall report

to the appropriate committees of Congress on the activities of the

States carried out pursuant to section 1211. Such report shall

include an assessment of the extent to which Federal and State

efforts to develop systems of trauma care and to designate trauma

centers have reduced the incidence of mortality, and the incidence

of permanent disability, resulting from trauma. Such report may

include any recommendations of the Secretary for appropriate

administrative and legislative initiatives with respect to trauma

care.’’.

SEC. 12. FUNDING.

Section 1232 of the Public Health Service Act (42 U.S.C. 300d–

32) is amended to read as follows:

‘‘SEC. 1232. FUNDING.

‘‘(a) AUTHORIZATION OF APPROPRIATIONS.—For the purpose of

carrying out parts A and B, subject to subsections (b) and (c),

there are authorized to be appropriated $12,000,000 for fiscal year

42 USC 300d–16.

121 STAT. 98 PUBLIC LAW 110–23—MAY 3, 2007

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.’’.

PUBLIC LAW 110–23—MAY 3, 2007 121 STAT. 99

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.

Æ

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 ‘‘DEMONSTRA- TION’’.

Approved May 3, 2007.