59–010 

Calendar No. 667 

109TH CONGRESS REPORT " ! SENATE 2d Session 109–362 

KEEPING SENIORS SAFE FROM FALLS AND REAUTHORIZATION OF THE TRAUMATIC BRAIN INJURY ACT 

DECEMBER 5, 2006.—Ordered to be printed 

Mr. ENZI, from the Committee on Health, Education, Labor, and 

Pensions, submitted the following 

R E P O R T 

[To accompany S. 1531] 

The Committee on Health, Education, Labor, and Pensions, to 

which was referred the bill (S. 1351) to direct the Secretary of 

Health and Human Services to expand and intensify programs with 

respect to research and related activities concerning elder falls, 

having considered the same, reports favorably thereon with an 

amendment, and an amendment to the title, and recommends that 

the bill (as amended) do pass. 

CONTENTS 

Page 

I. Purpose and Need for Legislation ................................................................ 1 

II. Summary ........................................................................................................ 3 

III. History of Legislation and Votes in Committee .......................................... 3 

IV. Explanation of Bill and Committee Views ................................................... 4 

V. Cost Estimate ................................................................................................. 5 

VI. Regulatory Impact Statement ....................................................................... 7 

VII. Application of Law to the Legislative Branch ............................................. 7 

VIII. Section-by-Section Analysis .......................................................................... 7 

IX. Changes in Existing Law .............................................................................. 10 

I. PURPOSE AND NEED FOR LEGISLATION

The purpose of ‘‘Keeping Elders Safe from Falls and Reauthorization of the Traumatic Brain Injury Act’’ is to direct the Secretary 

of Health and Human Services (HHS) to expand and intensify programs with respect to research and related activities concerning 

traumatic brain injury (TBI) and elder falls. In older Americans, 

falling is the leading cause of injury and death, and the main cause 

of TBI. Every year, of the 1.4 million people in the United States 


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who sustain a TBI, 50,000 die and 235,000 are hospitalized. According to the Centers for Disease Control and Prevention (CDC), 

falls among older adults and traumatic brain injuries cost the 

United States an estimated 80 billion dollars in 2000. 

TBI is defined as brain damage from some externally inflicted 

trauma to the head that results in significant impairment to an individual’s physical, psychosocial, and/or cognitive functional abilities. According to CDC, brain injuries are among the most likely 

types of injury to cause death or permanent disability. People ages 

15 to 24 years and those over age 75 are the two age groups at 

highest risk for TBI. Motor vehicle accidents, sports accidents, falls, 

and violence are the major causes of TBI. Whereas motor vehicle 

accidents and violence, such as firearm assaults and child abuse, 

account for 70% of TBI in the overall US population, falling is the 

major cause in people aged 75 years or older. TBI is also caused 

by explosives, and medical experts have described it as the signature wound of the Iraq war. Long known as the silent epidemic, 

TBI can strike anyone—infant, youth, or elderly person—without 

warning and with devastating results. It is particularly common 

among young males and people of both sexes who are 75 years and 

older. TBI affects the whole family and often results in huge medical and rehabilitation expenses over a lifetime. 

TBI is different from other disabilities due to the severity of cognitive loss. Most rehabilitation programs are designed for people 

with physical disabilities, not cognitive disabilities that require 

special accommodations. Finding needed services is typically a 

logistical, financial, and psychological challenge for family members 

and other caregivers, because few coordinated systems of care exist 

for individuals with TBI. The passage of the Traumatic Brain Injury Act of 1996 has improved TBI service systems at the statelevel and also increased the overall visibility of TBI. However, more 

work needs to be done at both the national and State level to build 

an effective, durable service system for meeting the needs of individuals with TBI and their families. 

More than one-third of adults aged 65 and older fall each year. 

According to the CDC, in 2002, more than 12,800 people aged 65 

and older died from fall-related injuries. More than 1.6 million seniors were treated that year in emergency departments for fall-related injuries. Hospital admissions for hip fractures among the elderly have increased from 321,000 admissions in 1988 to 327,000 

in 2001. Annually, more than 80,000 individuals who are over 65 

years of age sustain a TBI as a result of a fall. 

In addition to their effect on the quality of life of seniors and 

their families, falls also have an impact on healthcare costs due to 

increased physician visits, emergency room use and hospitalization. 

According to the CDC, the direct medical cost totaled 179 million 

dollars for fatal and 19 billion dollars for nonfatal fall injuries in 

2000. 

To address the impact of falls on seniors, their families, and 

healthcare costs, the Keeping Elders Safe from Falls and Reauthorization of the Traumatic Brain Injury Act of 2006 would focus ongoing Federal efforts to prevent falls among older adults on three priorities: (1) developing a national education campaign to reduce falls 

among older adults; (2) intensifying services and conducting research to determine the most effective approaches to preventing 


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and treating falls among older adults; and (3) directing the Secretary of Health and Human Services (HHS) to evaluate the effect 

of falls on health care costs, the potential for reducing falls, and 

the most effective strategies for reducing health care costs associated with falls. 

II. SUMMARY

The purpose of this legislation is to expand and improve programs that authorize activities related to TBI and to reduce falls 

among the elderly. With respect to TBI, the legislation authorizes 

three federal agencies to carry out activities addressing TBI: 

(1) The Centers for Disease Control and Prevention (CDC) 

carries out projects that reduce the incidence of TBI through 

research, public education, and a national education and 

awareness campaign, gives grants to States to operate TBI registries, and funds academic research supporting the development of registries. 

(2) Supports basic and applied research conducted by the National Institutes of Health (NIH). 

(3) Health Resources Service Administration (HRSA) awards 

grants to fund State demonstration projects to improve access 

to health and other services and for protection and advocacy 

service systems. 

With respect to the issue of senior falls the legislation directs the 

Department of Health and Human Services (HHS) to: 

(1) Develop public education programs on fall prevention for 

the elderly, family members, caregivers, and others involved 

with the elderly. 

(2) Intensify services and conduct research to determine the 

most effective approaches to preventing and treating falls 

among older adults; and 

(3) Evaluate the effect of falls on health care costs, the potential for reducing falls, and the most effective strategies for 

reducing health care costs associated with falls. 

III. HISTORY OF LEGISLATION AND VOTES IN COMMITTEE

S. 1531, Keeping Seniors Safe from Falls Act and Reauthorization of the Traumatic Brain Injury Act is a combination of two 

bills—The Keeping Seniors Safe from Falls Act and the Traumatic 

Brain Injury Reauthorization. On September 20, 2006, the committee considered and unanimously approved a manager’s amendment to S. 1531. Senators MIKULSKI, HATCH, KENNEDY, 

DEWINE, MURRAY, and ISAKSON cosponsored the manager’s 

amendment. 

During the 109th Congress, S. 1531, The Keeping Seniors Safe 

from Falls Act was introduced by Senator ENZI for himself and 

Senator MIKULSKI on July 28, 2005. Senators BAUCUS, DOLE, 

GRASSLEY, COCHRAN, DURBIN, ISAKSON and MURRAY cosponsored the bill. 

The legislation was first introduced during the 107th Congress, 

on February 7, 2002, by Senator HUTCHINSON, for himself and 

Senators MIKULSKI and ENZI, as S. 1922. 


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Senators BAUCUS, MILLER and MURRAY also cosponsored S. 

1922. The Health, Education, Labor, and Pensions (HELP) Subcommittee on Aging held a hearing on S. 1922 on June 11, 2002. 

The bill was reintroduced as S. 1217 during the 108th Congress 

on June 9, 2003, by Senator ENZI, for himself and Senator MIKULSKI. Senators MURRAY, BAUCUS, GRASSLEY, COCHRAN, 

LAUTENBERG, BINGAMAN, and BUNNING also cosponsored S. 

1217. On September 22, 2004, the HELP Committee considered a 

substitute amendment to S. 1217 offered by Senators ENZI and 

MIKULSKI, which was approved by unanimous consent. 

The Traumatic Brain Injury Act Reauthorization of 2006 was introduced by Senator HATCH for himself and Senator KENNEDY 

on July 16, 2006. 

The original Traumatic Brain Injury Act, introduced by Senator 

HATCH for himself and Senator KENNEDY, was signed into law 

(P.L. 104–166) on July 29, 1996. On September 20, 2000, Senator 

HATCH introduced the Traumatic Brain Injury Act Amendments 

of 2000 to reauthorize the program. The bill was included as part 

of the Children’s Health Act (P.L. 106–310), which was signed into 

law on October 17, 2000. 

IV. EXPLANATION OF BILL AND COMMITTEE VIEWS

The Keeping Seniors Safe from Falls Act and Reauthorization of 

the Traumatic Brain Injury Act directs the Secretary of HHS to intensify and expand the Department’s efforts to prevent and treat 

injuries. The legislation focuses on traumatic brain injury and reducing and preventing falls among older adults. The committee authorizes from 2007 through 2010 such sums as may be necessary 

for TBI programs and elder falls programs administered by the 

Centers for Disease Control and Prevention (CDC), the Health Resources Service Administration (HRSA) and the National Institutes 

of Health (NIH). 

Minor changes are made to TBI activities administered by CDC 

and NIH to improve prevention and research activities. A collaborative study between CDC and NIH is authorized to determine the 

incidence and prevalence of TBI; collect, maintain and report national trends; identify common therapeutic interventions; and develop practice guidelines. The committee also sees it necessary for 

other Federal agencies such as the Department of Defense (DOD), 

which conducts TBI research, to be consulted for the report. This 

will more effectively coordinate and maximize efforts at the Federal 

level to better understand TBI. 

The HRSA grant program was amended to improve access to rehabilitation and other services related to TBI. Recognizing that TBI 

is a leading cause of death and disability among American Indians/ 

Alaska Indians, tribal communities are eligible to apply for grants. 

The efficiency of protection and advocacy grants is strengthened by 

directing HRSA and Administration on Developmental Disabilities 

(ADD) to coordinate data collection related to services. Payments 

for grants shall be distributed no later than October 1 of each fiscal 

year. 

The legislation directs the Secretary of HHS to refocus the Department’s efforts to prevent falls among older adults through public education and research, and to assess the impact that falls have 

on healthcare costs. The committee expects the Secretary to carry 


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out his authority through agencies, such as the CDC and its National Center for Injury Prevention and Control (NCIPC), which 

have the necessary experience and expertise to conduct and support such work. 

The committee expects the public education campaign to be directed principally to older adults, their families, and healthcare 

providers, and to be focused on the twin goals of reducing falls 

among older adults and preventing repeat falls. HHS or its designated agency should consider organizations with expertise in designing and implementing large-scale programs to prevent injuries; 

experience in working in cooperation with government agencies, 

businesses and corporate organizations; and other non-profit organizations and institutions and the capability to carry out major 

public education campaigns on a national basis. 

The committee believes that HHS should utilize the injury prevention and community health education expertise available at colleges and universities in carrying out provisions of this act. The 

committee urges HHS to involve these and other qualified organizations and institutions in the implementation of this legislation. 

The committee sees it necessary to raise the authorization of appropriations level for Part J—PREVENTION AND CONTROL OF 

ACTIVITIES, which is the authorization of appropriations line for 

injury prevention activities, including TBI and Elder Falls Activities, to be increased from $50 million to $58,361,000 for fiscal year 

2007 and such sums from 2008–2010. The increase is to meet the 

level appropriated by appropriators in fiscal year 2007, not to authorize new money. 

V. COST ESTIMATE

S. 1531—Keeping Seniors Safe From Falls and Reauthorization of 

the Traumatic Brain Injury Act 

Summary: S. 1531 would authorize appropriations for activities 

related to injuries and traumatic brain injury (TBI) conducted by 

the National Institutes of Health (NIH), the Centers for Disease 

Control and Prevention (CDC), and the Health Resources and Services Administration (HRSA). It also would authorize and expand 

certain ongoing activities at CDC related to injuries due to falls experienced by older Americans, and would allow consortia of American Indians to receive HRSA grants for improving access to TBI 

services. 

Assuming the appropriation of the authorized amounts, CBO estimates that implementing S. 1531 would cost $126 million in 2007 

and $1.6 billion over the 1007–2011 period. Enacting S. 1531 would 

not affect direct spending or revenues. 

S. 1531 contains no intergovernmental or private-sector mandates as defined in the Unfunded Mandates Reform Act (UMRA). 

Estimated cost to the Federal Government: The estimated budgetary impact is shown in the following table. The costs of this legislation fall within budget function 550 (health). 

Basis of estimate: For this estimate, CBO assumes that S. 1531 

will be enacted near the start of fiscal year 2007, that the necessary amounts will be appropriated for each fiscal year, and that 

outlays will follow the historical spending rates of similar NIH, 

CDC, and HRSA programs. 


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By fiscal year, in millions of dollars— 

2006 2007 2008 2009 2010 2011 

SPENDING SUBJECT TO APPROPRIATION 

Spending Under Current Law: 

Budget Authority 1 ................................................... 391 0 0 0 0 0 

Estimated Outlays ................................................... 391 260 44 15 1 0 

Proposed Changes: 

Estimated Authorization Level ................................. 0 399 411 417 426 0 

Estimated Outlays ................................................... 0 126 349 388 410 281 

Spending Under S. 1531: 

Estimated Authorization Level 1 .............................. 391 399 411 417 426 0 

Estimated Outlays ................................................... 391 386 393 403 411 281 

1 The 2006 level is the amount appropriated that year for trauma- and injury-related activities at NIH, CDC, and HRSA. 

S. 1531 would modify the Public Health Service Act to authorize 

funding through fiscal year 2010 for NIH and HRSA activities related to trauma and for CEC activities related to injuries and TBI. 

The bill would expand the scope of HRSA’s program of grants to 

improve access to TBI treatment by allowing consortia of American 

Indians to receive grants that currently are restricted to states. 

The bill would also require the CDC and NIH to conduct a study 

on the prevalence of TBI and the efficacy of medical interventions 

against it. CBO estimates that the NIH, CDC, and HRSA would require budget authority of $399 million for 2007 and $1.7 billion for 

the 2007–2011 period to carry out the activities specified in S. 

1531. That total is equivalent to the 2006 appropriation level with 

an adjustment for anticipated inflation. Assuming appropriation of 

the necessary amounts, CBO estimates that implementing S. 1531 

would cost $126 million in 2007 and $1.6 billion over the 2007– 2011 period. The NIH estimates that it will allocate $325 million to traumarelated activities in 2006. S. 1531 would authorize the appropriation of such sums as are necessary for such activities over the 

2007–2010 period. Based on historical program expenditures at 

NIH and adjusting for inflation, CBO estimates that it would require budget authority of $333 million for 2007 and $1.4 billion 

over the 2007–2011 period to conduct the authorized activities. Implementing S. 1531 at the NIH would cost $99 million in 2007 and $1.3 billion over the 2007–2011 period, CBO estimates, assuming appropriation of the necessary amounts and that spending for 

the programs would follow historical patterns for similar activities. 

Based on information from the CDC, CBO estimates that for 

2006 the CDC allocated about $58 million to research, education, 

and prevention activities described by S. 1531, including activities 

related to TBI and falls among the elderly. S. 1531 would authorize 

the appropriation for those activities of $58 million for 2007, and 

such sums as are necessary for those activities for fiscal years 2008 

through 2010. The bill also would direct CDC to engage in new research, education campaigns, and demonstration programs related 

to the effects and prevention of injuries due to falls among seniors. 

CBO estimates that CDC would require $250 million in budget authority over the 2007–2011 periods, including the $58 million that 

would be authorized for 2007, to implement those previsions. Based 

on historical spending patterns for similar activities, and assuming 

appropriation of authorized and necessary amounts, CBO estimates 

that implementing continued CDC activities would cost $23 million 

in 2007 and $236 million over the 2007–2011 period. 


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HRSA allocated $8 million in 2006 for grants to states to expand 

access to care for TBI. S. 1531 would authorize the appropriation 

of such sums as are necessary for those activities over the 2007–

2010 period, and would expand the program to allow consortia of 

American Indians to receive such grants. Based on historical 

spending of the programs, VBO estimates that the agency would 

require budget authority of $8 million in 2007 and $36 million over 

the 2007–2011 period to carry out activities specified during the period specified by the bill. CBO estimates that implementing those 

provisions of S. 1531 would cost $4 million in 2007 and $36 million 

over the 2007–2011 period, assuming appropriation of necessary 

amounts and that future rates of spending follow historical patterns for similar activities. 

Intergovernmental and Private-Sector Impact: S. 1531 contains 

no intergovernmental or private-sector mandates as defined in 

UMRA. State governments and Indian consortia would benefit from 

grant funding authorized by the bill. Any costs incurred by those 

entities to qualify for such grants would be incurred voluntarily as 

conditions of federal assistance. 

Estimate prepared by: Federal Costs: Tim Gronniger, Camile 

Williams. Impact on State, Local, and Tribal Governments: Leo 

Lex. Impact on the Private Sector: Paige Shevlin. 

Estimate approved by: Peter H. Fontaine, Deputy Assistant Director for Budget Analysis. 

VI. REGULATORY IMPACT STATEMENT

Pursuant to the requirements of paragraph 11(b) of rule XXVI of 

the Standing Rules of the Senate, the committee has determined 

that the bill will not have a significant regulatory impact. 

VII. APPLICATION OF LAW TO THE LEGISLATIVE BRANCH

The Committee has determined there is no impact of this law on 

the legislative branch. 

VIII. SECTION-BY-SECTION ANALYSIS

Section 1. Short title 

Section 1 provides the short title of the bill, the Keeping Seniors 

Safe from Falls and Reauthorization of the Traumatic Brain Injury 

Act. 

Section 2. Conforming amendments relating to restructuring 

Section 2 redesignates (1) Section 393B as section 393A, (2) Section 393A as section 393B; and (3) section 393B as section 393C. 

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

Section 3 amends Part J of Title III of the Public Health Service 

Act as redesignated (42 U.S.C. 280b–1b) to authorize the dissemination of information related to TBI and the sequelae of secondary 

conditions arising from TBI upon an individual’s discharge from 

hospitals and emergency centers. 

Section 393C of the Public Health Service Act, as redesignated 

(42 U.S.C. 280B et seq.) is amended to change the heading of the 


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section to ‘‘National Program for Traumatic Brain Injury Surveillance and Registry.’’ This section authorizes grants to States or 

their designees to develop or operate the State’s TBI surveillance 

system or registry to determine the incidence and prevalence of 

TBI. The Secretary is authorized to ensure the uniformity of reporting information. Also directs individuals with TBI to be linked 

with academic institutions to conduct applied research that will 

support the development of such surveillance systems and registries as necessary. 

Sec. 4. Study of traumatic brain injury 

This section authorizes the CDC to conduct a study in coordination with the NIH to study activities related to TBI. Activities include determining the incidence and prevalence of TBI in all age 

groups; collecting, maintaining and reporting national trends; identifying interventions used for rehabilitation and their effectiveness; 

analyzing the adequacy of existing measures of outcomes and 

knowledge of factors influencing differential outcomes; and developing guidelines for patient rehabilitation after TBI. 

The report shall be submitted to Congress no later than 3 years 

after the date of enactment. 

Sec. 5. Traumatic Brain Injury Programs of the National Institutes 

of Health 

This section reauthorizes the current grant program to conduct 

basic and clinical research on trauma, including diagnosis treatment rehabilitation, and general management of trauma and TBI. 

This section authorizes such sums as may be necessary for each 

fiscal years 2007–2010. 

Sec. 6. Traumatic Brain Injury Programs of all Health Resources 

and Service Administration 

This section reauthorizes the Secretary to award grants to 

States, and authorizes the Secretary to award grants to American 

Indian Consortia, for the purpose of carrying out projects to improve access to health and other services regarding TBI. 

This section authorizes the Secretary to submit to the committees of jurisdiction no less than bi-annually, a report describing the 

findings, and results of the programs established under this section, including measures outcomes and consumer and surrogate 

satisfaction. The surrogate refers to the individual who has the authority to make decisions on behalf of the individual receiving TBI 

services. 

Definitions in this section include American Indian consortium 

and TBI. 

Grants are authorized for such sums as may be necessary for 

each of the fiscal years 2007 through 2010. 

This section authorizes the Secretary to award grants to protection and advocacy systems for the purpose of enabling such systems to provide services to individuals with TBI. 

This section directs the Administration to pay directly to any 

protection and advocacy system that complies with the provisions 

of this section, no later than October 1. 

This section requires the Administrator of Health Resources 

Service Administration and the Commissioner of the AdministraVerDate Aug 31 2005 21:28 Dec 12, 2006 Jkt 059010 PO 00000 Frm 00008 Fmt 6659 Sfmt 6602 E:\HR\OC\SR362.XXX SR362

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tion of Developmental Disabilities to enter into an agreement to coordinate the collection of data by the Administrator and the Commissioner regarding protection and advocacy services. 

This section requires for any fiscal year for which the amount ap- propriated is $6 million or greater, the Administrator to use 2 percent of such amount to make a grant to an eligible national association for providing training and technical assistance for protection and advocacy systems. 

In this section, eligible national association means a national association with demonstrated experience in providing training and 

technical assistance to protection and advocacy systems. 

This section gives a protection and advocacy system the same authorities as such a system would for the purpose of providing services under subtitle C of the Developmental Disabilities Assistance 

and Bill of Rights Act of 2000. 

Sec. 7. Amendments to the Public Health Service Act Relating to 

Elder Falls 

Section 7 amends Part J of Title III of the Public Health Service 

Act to add a new section 393D, Prevention of Falls Among Older 

Adults. 

Subsection (a) directs HHS to establish a national public education campaign to prevent falls among older adults and prevent 

repeat falls. It also establishes authority for HHS to make grants 

or enter into contracts or cooperative agreements to assist statelevel coalitions in conducting local education campaigns to reduce 

falls among older adults. 

Subsection (b) directs HHS to conduct and support research in 

areas such as identifying older adults who have a high risk of falling; designing, implementing, and evaluating the most effective 

ways to prevent falls; improving diagnosis, treatment, and rehabilitation of older adults who have fallen; tailoring proven fall reduction strategies to specific populations of older adults; and eliminating barriers to adopting proven fall prevention methods. It also 

directs the HHS Secretary to make grants or enter into contracts 

or cooperative agreements to provide professional education for 

physicians, allied health professionals and aging service providers 

in fall prevention, evaluation and management. 

Subsection (c) gives HHS the authority to conduct and support 

demonstration programs to assess the utility of targeted fall risk 

screening and referral programs; programs that use multiple approaches to prevent falls; and programs targeting newly discharged 

fall victims at high risk for second falls. HHS may also conduct and 

support demonstration programs to develop technology to prevent 

falls among older adults and prevent or reduce fall-related injuries, 

and to implement and evaluate fall prevention programs using 

proven intervention strategies in different settings. 

Subsection (d) directs the Secretary to evaluate the effect of falls 

on health care costs, the potential for reducing falls, and the most 

effective strategies for reducing fall-related health care costs. 

Sec. 8. Authorization of Appropriations 

This section authorizes the appropriation of $58,361,000 for fiscal 

year 2007 and such sums as may be necessary for fiscal years 2007 

through 2010. 


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IX. CHANGES IN EXISTING LAW

In compliance with rule XXVI paragraph 12 of the Standing 

Rules of the Senate, the following provides a print of the statute 

or the part or section thereof to be amended or replaced (existing 

law proposed to be omitted is enclosed in black brackets, new matter is printed in italic, existing law in which no change is proposed 

is shown in roman): 

PUBLIC HEALTH SERVICE ACT 

* * * * * * * 

TITLE III—GENERAL POWERS AND DUTIES OF PUBLIC 

HEALTH SERVICE 

PART A—RESEARCH AND INVESTIGATION

* * * * * * * 

PART J—PREVENTION AND CONTROL OF INJURIES

RESEARCH

SEC. 391. (a) * * * 

* * * * * * * 

INTERPERSONAL VIOLENCE WITHIN FAMILIES AND AMONG

ACQUAINTANCES

SEC. 393. (a) * * * 

* * * * * * * 

SEC. ø393B¿ 393A. USE OF ALLOTMENTS FOR RAPE PREVENTION EDUCATION. 

(a) PERMITTED USE.—* * * 

* * * * * * * 

PREVENTION OF TRAUMATIC BRAIN INJURY

SEC. ø393A¿ 393B. (a) IN GENERAL.—* * * 

(b) * * * 

(1) * * * 

* * * * * * * 

(3) the implementation of a national education and awareness campaign regarding such injury (in conjunction with the 

program of the Secretary regarding health-status goals for 

2010, commonly referred to as Healthy People 2010), including—

(A) the national dissemination of information on—

(i) incidence and prevalence; and 

(ii) information relating to traumatic brain injury 

and the sequelae of secondary conditions arising from 

traumatic brain injury upon discharge øfrom hospitals 

and trauma centers¿ from hospitals and emergency departments; and 

* * * * * * * 


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NATIONAL PROGRAM FOR TRAUMATIC BRAIN INJURY SURVEILLANCE

AND REGISTRIES

SEC. ø393B¿ 393C. ø(a) IN GENERAL.—¿The Secretary, acting 

through the Director of the Centers for Disease Control and Prevention, ømay make grants to States or their designees to operate 

the State’s traumatic brain injury registry, and to academic institutions to conduct applied research that will support the development 

of such registries, to collect data concerning—¿ may make grants 

to States or their designees to develop or operate the State’s traumatic brain injury surveillance system or registry to determine the 

incidence and prevalence of traumatic brain injury and related disability, to ensure the uniformity of reporting under such system or 

registry, to link individuals with traumatic brain injury to services 

and supports, and to link such individuals with academic institutions to conduct applied research that will support the development 

of such surveillance systems and registries as may be necessary. A 

surveillance system or registry under this section shall provide for 

the collection of data concerning—

* * * * * * * 

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

(a) STUDY.—The Secretary, acting through the Director of the 

Centers for Disease Control and Prevention with respect to paragraph (1) and the Director of the National Institutes of Health with 

respect to paragraphs (2) and (3), shall conduct a study with respect 

to traumatic brain injury for the purpose of carrying out the following: 

(1) In collaboration with appropriate State and local healthrelated agencies—

(A) determining the incidence of traumatic brain injury 

and prevalence of traumatic brain injury related disability 

in all age groups in the general population of the United 

States, including institutional settings, such as nursing 

homes, correctional facilities, psychiatric hospitals, child 

care facilities, and residential institutes for people with developmental disabilities; and 

(B) reporting national trends in traumatic brain injury. 

(2) Identifying common therapeutic interventions which are 

used for the rehabilitation of individuals with such injuries, 

and, subject to the availability of information, including an 

analysis of—

(A) the effectiveness of each such intervention in improving the functioning, including return to work or school and 

community participation, of individuals with brain injuries; 

(B) the comparative effectiveness of interventions employed in the course of rehabilitation of individuals with 

brain injuries to achieve the same or similar clinical outcome; and 

(C) the adequacy of existing measures of outcomes and 

knowledge of factors influencing differential outcomes. 

(3) Developing practice guidelines for the rehabilitation of 

traumatic brain injury at such time as appropriate scientific research becomes available. 


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(b) DATES CERTAIN FOR REPORTS.—Not later than 3 years after 

the date of the enactment of the Keeping Seniors Safe from Falls 

and Reauthorization of the Traumatic Brain Injury Act, the Secretary shall submit to the Congress a report describing findings 

made as a result of carrying out subsection (a). 

(c) DEFINITION.—For purposes of this section, the term ‘‘traumatic 

brain injury’’ means an acquired injury to the brain. Such term 

does not include brain dysfunction caused by congenital or degenerative disorders, nor birth trauma, but may include brain injuries 

caused by anoxia due to trauma. The Secretary may revise the definition of such term as the Secretary determines necessary. 

SEC. 393D. PREVENTION OF FALLS AMONG OLDER ADULTS. 

(a) PUBLIC EDUCATION.—The Secretary shall— (1) oversee and support a national education campaign to be 

carried out by a nonprofit organization with experience in designing and implementing national injury prevention programs, 

that is directed principally to older adults, their families, and 

health care providers, and that focuses on reducing falls among 

older adults and preventing repeat falls; and 

(2) award grants, contracts, or cooperative agreements to 

qualified organizations, institutions, or consortia of qualified 

organizations and institutions, for the purpose of organizing 

State-level coalitions of appropriate State and local agencies, 

safety, health, senior citizen, and other organizations to design 

and carry out local education campaigns, focusing on reducing 

falls among older adults and preventing repeat falls. 

(b) RESEARCH.— (1) IN GENERAL.—The Secretary shall— (A) conduct and support research to— (i) improve the identification of older adults who 

have a high risk of falling; 

(ii) improve data collection and analysis to identify 

fall risk and protective factors; 

(iii) design, implement, and evaluate the most effective fall prevention interventions; 

(iv) improve strategies that are proven to be effective 

in reducing falls by tailoring these strategies to specific 

populations of older adults; 

(v) conduct research in order to maximize the dissemination of proven, effective fall prevention interventions; 

(vi) intensify proven interventions to prevent falls 

among older adults; 

(vii) improve the diagnosis, treatment, and rehabilitation of elderly fall victims and older adults at high 

risk for falls; and 

(viii) assess the risk of falls occurring in various settings; 

(B) conduct research concerning barriers to the adoption 

of proven interventions with respect to the prevention of 

falls among older adults; 

(C) conduct research to develop, implement, and evaluate 

the most effective approaches to reducing falls among highrisk older adults living in communities and long-term care 

and assisted living facilities; and 


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(D) evaluate the effectiveness of community programs designed to prevent falls among older adults. 

(2) EDUCATIONAL SUPPORT.—The Secretary, either directly or 

through awarding grants, contracts, or cooperative agreements 

to qualified organizations, institutions, or consortia of qualified 

organizations and institutions, shall provide professional education for physicians and allied health professionals, and aging 

service providers in fall prevention, evaluation, and management. 

(c) DEMONSTRATION PROJECTS.—The Secretary shall carry out the 

following: 

(1) Oversee and support demonstration and research projects 

to be carried out by qualified organizations, institutions, or consortia of qualified organizations and institutions, in the following areas: 

(A) A multistate demonstration project assessing the utility of targeted fall risk screening and referral programs. 

(B) Programs designed for community-dwelling older 

adults that utilize multicomponent fall intervention approaches, including physical activity, medication assessment and reduction when possible, vision enhancement, 

and home modification strategies. 

(C) Programs that are targeted to new fall victims who 

are at a high risk for second falls and which are designed 

to maximize independence and quality of life for older 

adults, particularly those older adults with functional limitations. 

(D) Private sector and public-private partnerships to develop technologies to prevent falls among older adults and 

prevent or reduce injuries if falls occur. 

(2)(A) Award grants, contracts, or cooperative agreements to 

qualified organizations, institutions, or consortia of qualified 

organizations and institutions, to design, implement, and evaluate fall prevention programs using proven intervention strategies in residential and institutional settings. 

(B) Award 1 or more grants, contracts, or cooperative agreements to 1 or more qualified organizations, institutions, or consortia of qualified organizations and institutions, in order to 

carry out a multistate demonstration project to implement and 

evaluate fall prevention programs using proven intervention 

strategies designed for single and multifamily residential settings with high concentrations of older adults, including—

(i) identifying high-risk populations; 

(ii) evaluating residential facilities; 

(iii) conducting screening to identify high-risk individuals; 

(iv) providing fall assessment and risk reduction interventions and counseling; 

(v) coordinating services with health care and social service providers; and 

(vi) coordinating post-fall treatment and rehabilitation. 

(3) Award 1 or more grants, contracts, or cooperative agreements to qualified organizations, institutions, or consortia of 

qualified organizations and institutions, to conduct evaluations 


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of the effectiveness of the demonstration projects described in 

this subsection. 

(d) STUDY OF EFFECTS OF FALLS ON HEALTH CARE COSTS.— (1) IN GENERAL.—The Secretary shall conduct a review of the 

effects of falls on health care costs, the potential for reducing 

falls, and the most effective strategies for reducing health care 

costs associated with falls. 

(2) REPORT.—Not later than 36 months after the date of enactment of the Keeping Seniors Safe from Falls and Reauthorization of the Traumatic Brain Injury Act, the Secretary shall 

submit to Congress a report describing the findings of the Secretary in conducting the review under paragraph (1). 

* * * * * * * 

AUTHORIZATIONS OF APPROPRIATIONS

SEC. 394A. For the purpose of carrying out this part, there are 

authorized to be appropriated ø$50,000,000 for fiscal year 1994, 

and1 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.¿ $58,361,000 for fiscal year 

2007, and such sums as may be necessary for each of fiscal years 

2008 through 2010. 

* * * * * * * 

SEC. 1252. STATE GRANTS FOR DEMONSTRATION 1 PROJECTS REGARDING TRAUMATIC BRAIN INJURY. 

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

make grants to States¿ may make grants to States and American 

Indian consortia for the purpose of carrying out projects to improve 

access to øhealth and other services¿ rehabilitation and other services regarding traumatic brain injury. 

(b) STATE ADVISORY BOARD.— (1) IN GENERAL.—The Secretary may make a grant under 

subsection (a) only if the øState¿ State or American Indian 

consortium involved agrees to establish an advisory board 

within the appropriate health department of the øState¿ State 

or American Indian consortium or within another department 

as designated by the chief executive officer of the øState¿ State 

or American Indian consortium. (2) FUNCTIONS.—An advisory board established under paragraph (1) shall advise and make ørecommendations to the 

State¿ recommendations to the State or American Indian consortium on ways to improve services coordination regarding 

traumatic brain injury. Such advisory boards shall encourage 

citizen participation through the establishment of public hearings and other types of community outreach programs. In developing recommendations under this paragraph, such boards 

shall consult with Federal, State, and local governmental agencies and with citizens groups and other private entities. 

(3) COMPOSITION.—An advisory board established under 

paragraph (1) shall be composed of—

(A) representatives of—

(i) the corresponding øState¿ State or American Indian consortium agencies involved; 


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(ii) public and nonprofit private health related organizations; 

(iii) other disability advisory or planning groups 

within the øState¿ State or American Indian consortium; 

(iv) members of an organization or foundation representing individuals with traumatic brain injury in 

that øState¿ State or American Indian consortium; 

and 

* * * * * * * 

(c) MATCHING FUNDS.—

(1) IN GENERAL.—with respect to costs to be incurred by a 

øState¿ 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 øState¿ State 

or American Indian consortium agrees to make available nonFederal contributions toward such costs in an amount that is 

not less than $1 for each $2 of Federal funds provided under 

the grant. 

(2) DETERMINATION OF AMOUNT CONTRIBUTED.—* * * 

* * * * * * * 

(e) CONTINUATION OF PREVIOUSLY AWARDED DEMONSTRATION

PROJECTS.—øA State that received a grant under this section prior 

to the date of the enactment of the Children’s Health Act of 2000 

may compete for new project grants under this section after such 

date of the enactment.¿ State or American Indian consortium that 

received a grant under this section prior to the date of the enactment of the Keeping Seniors Safe from Falls and Reauthorization 

of the Traumatic Brain Injury Act may complete the activities funded by the grant. 

(f) USE OF STATE AND AMERICAN INDIAN CONSORTIUM GRANTS.—

(1) COMMUNITY SERVICES AND SUPPORTS.—A øState¿ State or 

American Indian consortium shall (directly or through awards 

of contracts to nonprofit private entities) use amounts received 

under a grant under this section for the following: 

(A) * * * 

(i) * * * 

(ii) shall be designed for øchildren and other individuals¿ children, youth, and adults with traumatic brain 

injury. 

* * * * * * * 

(E) To support other needs identified by the advisory 

board under subsection (b) for the øState¿ State or American Indian consortium involved. 

(2) BEST PRACTICES.—

(A) IN GENERAL.—øState¿ 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 


hsrobinson on PROD1PC76 with HEARING
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as state-of-the-art health care and integrated community 

supports, regardless of the severity of injury. 

(B) DEMONSTRATION BY STATE AGENCY.—The øState¿ 

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 øState¿ State or American 

Indian consortium may use amounts received under a grant 

under this section to * * * 

* * * * * * * 

(E) tailor existing øState¿ State or American Indian consortium systems to provide accommodations to the needs of 

individuals with brain injury (including systems administered by the øState¿ State or American Indian consortium 

departments responsible for health, mental health, labor/ 

employment, education, mental retardation/developmental 

disorders, transportation, and correctional systems); 

(F) improve data sets coordinated across systems and 

other needs identified by a øState¿ State or American Indian consortium plan supported by its advisory council; 

and 

* * * * * * * 

(h) REPORT.—øNot later than 2 years after the date of the enactment of this section, the Secretary¿ Not less than bi-annually, the 

Secretary shall submit to the Committee on Commerce of the 

House of Representatives, and to the Committee on Labor and 

Human Resources of the Senate, a report describing the findings 

and results of the programs established under this section, section 

1253, and section 1254, including measures of outcomes and consumer and surrogate satisfaction. 

ø(i) DEFINITION.—For purposes of this section, the term ‘‘traumatic brain injury’’ means an acquired injury to the brain. Such 

term does not include brain dysfunction caused by congenital or degenerative disorders, nor birth trauma, but may include brain injuries caused by anoxia due to trauma. The Secretary may revise the 

definition of such term as the Secretary determines necessary, after 

consultation with States and other appropriate public or nonprofit 

private entities.¿ 

(i) DEFINITIONS.—For purposes of this section: 

(1) The terms ‘‘American Indian consortium’’ and ‘‘State’’

have the meanings given to those terms in section 1253. 

(2) The term ‘‘traumatic brain injury’’ means an acquired injury to the brain. Such term does not include brain dysfunction 

caused by congenital or degenerative disorders, nor birth trauma, but may include brain injuries caused by anoxia due to 

near drowning. 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. 

(j) AUTHORIZATION OF APPROPRIATIONS.—For the purpose of carrying out this section, there are authorized to be appropriated such 

sums as may be necessary for each of the fiscal years 2001 through 


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2005, and such sums as may be necessary for each of the fiscal 

years 2007 through 2010. 

* * * * * * * 

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

(a) IN GENERAL.—* * * 

* * * * * * * 

(d) APPROPRIATIONS LESS THAN $2,700,000.—

(1) IN GENERAL.—With respect to any fiscal year in which 

the amount appropriated under øsubsection (i)¿ subsection (l) 

to carry out this section is less than $2,700,000, the Administrator shall make grants from such amount to individual protection and advocacy systems within States to enable such systems to plan for, develop outreach strategies for, and carry out 

services authorized under this section for individuals with 

traumatic brain injury. 

(2) * * * 

(e) APPROPRIATIONS OF $2,700,000 OR MORE.—

(1) POPULATION BASIS.—Except as provided in paragraph (2), 

with respect to each fiscal year in which the amount appropriated under øsubsection (i)¿ subsection (l) to carry out this 

section is $2,700,000 or more, the Administrator shall make a 

grant to a protection and advocacy system within each State. 

(2) AMOUNT.—The amount of a grant provided to a system 

under paragraph (1) shall be equal to an amount bearing the 

same ratio to the total amount appropriated for the fiscal year 

involved under øsubsection (i)¿ subsection (l) as the population 

of the State in which the grantee is located bears to the population of all States. 

(3) * * * 

* * * * * * * 

(4) INFLATION ADJUSTMENT.—For each fiscal year in which 

the total amount appropriated under øsubsection (i)¿ subsection (l) to carry out this section is $5,000,000 or more, and 

such appropriated amount exceeds the total amount appropriated to carry out this section in the preceding fiscal year, 

the Administrator shall increase each of the minimum grants 

amount described in subparagraphs (A) and (B) of paragraph 

(3) by a percentage equal to the percentage increase in the 

total amount appropriated under øsubsection (i)¿ subsection (l) 

to carry out this section between the preceding the fiscal year 

and the fiscal year involved. 

* * * * * * * 

(g) DIRECT PAYMENT.—Notwithstanding any other provision of 

law, each fiscal year not later than October 1, the Administrator 

shall pay directly to any protection and advocacy system that complies with the provisions of this section the total amount of the 

grant for such system, unless the system provides otherwise for 

such payment. 

(h) * * * 

* * * * * * * 


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(i) DATA COLLECTION.—The Administrator of the Health Resources and Services Administration and the Commissioner of the 

Administration on Developmental Disabilities shall enter into an 

agreement to coordinate the collection of data by the Administrator 

and the Commissioner regarding protection and advocacy services. 

(j) TRAINING AND TECHNICAL ASSISTANCE.—

(1) GRANTS.—For any fiscal year for which the amount appropriated to carry out this section is $6,000,000 or greater, the 

Administrator shall use 2 percent of such amount to make a 

grant to an eligible national association for providing for training and technical assistance to protection and advocacy systems. 

(2) DEFINITION.—In this subsection, the term ‘‘eligible national association’’ means a national association with demonstrated experience in providing training and technical assistance to protection and advocacy systems. 

(k) SYSTEM AUTHORITY.—In providing services under this section, 

a protection and advocacy system shall have the same authorities, 

including access to records, as such system would have for purpose 

of providing services under subtitle C of the Developmental Disabilities Assistance and Bill of Rights Act of 2000. 

ø(i)¿ (l) AUTHORIZATION OF APPROPRIATIONS.—There are authorized to be appropriated to carry out this section $5,000,000 for fiscal year 2001, and such sums as may be necessary for each the fiscal years 2002 through ø2005¿ 2010. 

ø(j)¿ (m) * * * 

* * * * * * * 

PART F—INTERAGENCY PROGRAM FOR TRAUMA RESEARCH

SEC. 1261. ESTABLISHMENT OF PROGRAM. 

(a) IN GENERAL.—* * * 

* * * * * * * 

(d) CERTAIN ACTIVITIES OF PROGRAM.—The Program shall include—

(1) * * * 

* * * * * * * 

(4) * * * 

(A) * * * 

* * * * * * * 

(D) the development of programs that increase the participation of academic centers of excellence in øhead brain 

injury¿ brain injury treatment and rehabilitation research 

and training; and 

* * * * * * * 

(i) AUTHORIZATION OF APPROPRIATIONS.—For the purpose of carrying out this section, there are authorized to be appropriated such 

sums as may be necessary for each of the fiscal years 2001 through 


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2005, and such sums as may be necessary for each of fiscal years 

2007 through 2010. 

* * * * * * * 

Æ 


hsrobinson on PROD1PC76 with HEARING