39–006 

113TH CONGRESS REPORT " ! HOUSE OF REPRESENTATIVES 2d Session 113–459 

TRAUMA SYSTEMS AND REGIONALIZATION OF 

EMERGENCY CARE REAUTHORIZATION ACT 

MAY 20, 2014.—Committed to the Committee of the Whole House on the State of 

the Union and ordered to be printed 

Mr. UPTON, from the Committee on Energy and Commerce, 

submitted the following 

R E P O R T 

[To accompany H.R. 4080] 

[Including cost estimate of the Congressional Budget Office] 

The Committee on Energy and Commerce, to whom was referred 

the bill (H.R. 4080) to amend title XII of the Public Health Service 

Act to reauthorize certain trauma care programs, and for other 

purposes, having considered the same, report favorably thereon 

with an amendment and recommend that the bill as amended do 

pass. 

CONTENTS 

Page 

Amendment .............................................................................................................. 2 

Purpose and Summary ............................................................................................ 2 

Background and Need for Legislation .................................................................... 2 

Hearings ................................................................................................................... 3 

Committee Consideration ........................................................................................ 3 

Committee Votes ...................................................................................................... 3 

Committee Oversight Findings ............................................................................... 3 

Statement of General Performance Goals and Objectives .................................... 4 

New Budget Authority, Entitlement Authority, and Tax Expenditures ............. 4 

Earmark, Limited Tax Benefits, and Limited Tariff Benefits ............................. 4 

Committee Cost Estimate ....................................................................................... 4 

Congressional Budget Office Estimate ................................................................... 4 

Federal Mandates Statement ................................................................................. 5 

Duplication of Federal Programs ............................................................................ 6 

Disclosure of Directed Rule Makings ..................................................................... 6 

Advisory Committee Statement .............................................................................. 6 

Applicability to Legislative Branch ........................................................................ 6 

Section-by-Section Analysis of the Legislation ...................................................... 6 

Changes in Existing Law Made by the Bill, as Reported ..................................... 6 


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1http://www.cdc.gov/traumacare/pdfs/traumacentersfactsheet20090921-a.pdf. 

AMENDMENT

The amendment is as follows: 

Strike all after the enacting clause and insert the following: 

SECTION 1. SHORT TITLE. 

This Act may be cited as the ‘‘Trauma Systems and Regionalization of Emergency 

Care Reauthorization Act’’. 

SEC. 2. REAUTHORIZATION OF CERTAIN TRAUMA CARE PROGRAMS. 

Section 1232(a) of the Public Health Service Act (42 U.S.C. 300d–32(a)) is amended by striking ‘‘2014’’ and inserting ‘‘2019’’. 

SEC. 3. IMPROVEMENTS AND CLARIFICATIONS TO CERTAIN TRAUMA CARE PROGRAMS. 

(a) ALLOCATION OF FUNDS FOR COMPETITIVE GRANTS FOR REGIONALIZED SYSTEMS

FOR EMERGENCY CARE RESPONSE.—Section 1232(c) of the Public Health Service Act 

(42 U.S.C. 300d–31(c)) is amended—— 

(1) in paragraph (1), by striking ‘‘and’’ at the end; 

(2) in paragraph (2), by striking the period at the end and inserting ‘‘; and’’; 

and 

(3) by adding at the end the following new paragraph: 

‘‘(3) for a fiscal year after fiscal year 2014, not more than 50 percent of such 

amounts remaining for such fiscal year after application of paragraphs (1) and 

(2) shall be allocated for the purpose of carrying out section 1204.’’. 

(b) CLARIFICATIONS UNDER TRAUMA SYSTEMS FORMULA GRANTS REQUIREMENTS

RELATING TO THE AMERICAN BURN ASSOCIATION.—Section 1213 of the Public Health 

Service Act (42 U.S.C. 300d–13) is amended—— 

(1) in subsection (a)(3), by inserting ‘‘and (for a fiscal year after fiscal year 

2014) contains national standards and requirements of the American Burn Association for the designation of verified burn centers,’’ after ‘‘such entity,’’; 

(2) in subsection (b)(3)(A), by striking ‘‘and the American Academy of Pediatrics,’’ and inserting ‘‘the American Academy of Pediatrics, and (for a fiscal year 

after fiscal year 2014) the American Burn Association,’’; and 

(3) in subsection (c)(1)—— 

(A) in the matter preceding subparagraph (A), by inserting ‘‘and not later 

than 1 year after the date of the enactment of the Trauma Systems and 

Regionalization of Emergency Care Reauthorization Act’’ after ‘‘Act of 

2007’’; and 

(B) in subparagraph (A), by striking ‘‘and the American Academy of Pediatrics’’ and inserting ‘‘the American Academy of Pediatrics, and (with respect to the update pursuant to the Trauma Systems and Regionalization 

of Emergency Care Reauthorization Act) the American Burn Association’’. 

(c) CONFORMING AMENDMENTS.—Part B of title XII of the Public Health Service 

Act is amended—— 

(1) in section 1218(c)(2) (42 U.S.C. 300d–18(c)(2)), in the matter preceding 

subparagraph (A), by striking ‘‘1232(b)(3)’’ and inserting ‘‘section 1232(b)’’; and 

(2) in section 1222 (42 U.S.C. 300d–22), by striking ‘‘October 1, 2008’’ and inserting ‘‘October 1, 2016’’. 

PURPOSE AND SUMMARY

H.R. 4080, ‘‘Trauma Systems and Regionalization of Emergency 

Care Reauthorization Act’’ was introduced on February 25, 2014, 

by Rep. Michael Burgess (R–TX) and Rep. Gene Green (D–TX) and 

referred to the Committee on Energy and Commerce. The legislation would amend the Public Health Service Act (PHSA) to reauthorize certain trauma care programs and for other purposes. 

BACKGROUND AND NEED FOR LEGISLATION

Traumatic injury is the leading cause of death for those under 

the age of 45.1 The care received in the first hour or the ‘‘golden 

hour’’ after a traumatic injury presents the highest likelihood that 


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2https://www.oumedicine.com/oumedicalcenter/medical-services-and-departments/traumaone-center/what-is-the-golden-hour-. 3http://www.cdc.gov/traumacare/pdfs/traumacentersfactsheet20090921-a.pdf. 

4http://www.nhtsa.gov/People/injury/ems/emstraumasystem03/traumasystem.htm. 

5http://www.amtrauma.org/resources/trauma-categorization/index.aspx. 

the patient will survive.2 From 1990 to 2005, 30 percent of trauma 

centers closed, leaving 45 million Americans, including vulnerable 

populations, without access to rapid intervention after a traumatic 

injury. Without that immediate care, their survival rates decrease 

by 25 percent.3

A trauma system is an organized, coordinated effort in a defined 

geographic area that delivers the full range of care to injured patients. It provides resources, supporting equipment and personnel, 

along a continuum of care, including pre-hospital, hospital, and rehabilitation services.4 While trauma centers are known for saving 

lives from shootings, car accidents, or mass casualty events, most 

injuries are caused by falls and occur among the elderly and children. Trauma centers are designed to treat different levels of injury 

and classified by levels ranging from level 1, which provides care 

to the most seriously injured, to level 5, for those with less serious 

injuries.5

The bill would reauthorize Trauma Care Systems Planning 

Grants, which support State development of trauma systems. It 

also would reauthorize pilot projects to implement and assess the 

regionalized emergency care model, including grants for improving 

trauma care and access to high-quality trauma care. 

HEARINGS

The Committee on Energy and Commerce has not held hearings 

on the legislation. 

COMMITTEE CONSIDERATION

On February 27, 2014, the Subcommittee on Health met in open 

markup session and favorably forwarded H.R. 4080 to the full Committee, as amended, by a voice vote. On April 3, 2014, the Energy 

and Commerce Committee met in open markup session and approved H.R. 4080, as amended, by unanimous consent. 

COMMITTEE VOTES

Clause 3(b) of rule XIII of the Rules of the House of Representatives requires the Committee to list the record votes on the motion 

to report legislation and amendments thereto. There were no 

record votes taken in connection with ordering H.R. 4080 reported. 

A motion by Mr. Upton to order H.R. 4080 reported to the House, 

as amended, was agreed to by unanimous consent. 

COMMITTEE OVERSIGHT FINDINGS

Pursuant to clause 3(c)(1) of rule XIII of the Rules of the House 

of Representatives, the Committee held a hearing and made findings that are reflected in this report. 


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STATEMENT OF GENERAL PERFORMANCE GOALS AND OBJECTIVES

Pursuant to clause 3(c)(1) of rule XIII of the House of Representatives, the goal of the legislation is to reauthorize trauma and 

emergency care systems grants established in the (PHSA). 

NEW BUDGET AUTHORITY, ENTITLEMENT AUTHORITY, AND TAX

EXPENDITURES

In compliance with clause 3(c)(2) of rule XIII of the Rules of the 

House of Representatives, the Committee finds that H.R. 4080 

would result in no new or increased budget authority, entitlement 

authority, or tax expenditures or revenues. 

EARMARK, LIMITED TAX BENEFITS, AND LIMITED TARIFF BENEFITS

In compliance with clause 9(e), 9(f), and 9(g) of rule XXI, the 

Committee finds that H.R. 4080 contains no earmarks, limited tax 

benefits, or limited tariff benefits. 

COMMITTEE COST ESTIMATE

The Committee adopts as its own the cost estimate prepared by 

the Director of the Congressional Budget Office pursuant to section 

402 of the Congressional Budget Act of 1974. 

CONGRESSIONAL BUDGET OFFICE ESTIMATE

Pursuant to clause 3(c)(3) of rule XIII of the Rules of the House 

of Representatives, the following is the cost estimate provided by 

the Congressional Budget Office pursuant to section 402 of the 

Congressional Budget Act of 1974: 

U.S. CONGRESS, 

CONGRESSIONAL BUDGET OFFICE, Washington, DC, April 16, 2014. 

Hon. FRED UPTON, Chairman, Committee on Energy and Commerce, 

House of Representatives, Washington, DC. 

DEAR MR. CHAIRMAN: The Congressional Budget Office has prepared the enclosed cost estimate for H.R. 4080, the Trauma Systems and Regionalization of Emergency Care Reauthorization Act. 

If you wish further details on this estimate, we will be pleased 

to provide them. The CBO staff contact is Lisa Ramirez-Branum. 

Sincerely, 

ROBERT A. SUNSHINE

(For Douglas W. Elmendorf, Director). 

Enclosure. 

H.R. 4080—Trauma Systems and Regionalization of Emergency 

Care Reauthorization Act 

Summary: H.R. 4080 would amend the Public Health Service Act 

to authorize funding for public and private entities that provide 

trauma and emergency care services and for the administration of 

the Federal Interagency Committee on Emergency Medical Services 

(FICEMS). 


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The bill would authorize the appropriation of $24 million a year 

for each of fiscal years 2015 through 2019. CBO estimates that implementing the bill would cost $101 million over the 2015–2019 period, assuming appropriation of the authorized amounts. Pay-asyou-go procedures do not apply to this legislation because it would 

not affect direct spending or revenues. 

The bill 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 of H.R. 4080 is shown in the following table. The costs 

of this legislation fall within budget function 550 (health). 

By fiscal year, in millions of dollars—— 

2015 2016 2017 2018 2019 2015– 

2019 

CHANGES IN SPENDING SUBJECT TO APPROPRIATION 

Authorization Level ....................................................................... 24 24 24 24 24 120 

Estimated Outlays ........................................................................ 10 21 23 23 24 101 

Basis of estimate: For this estimate, CBO assumes that H.R. 

4080 will be enacted before the end of fiscal year 2014, that the 

Congress will appropriate the authorized amounts, and that spending will follow historical patterns for similar programs. In fiscal 

year 2014, no funds were appropriated for the programs that would 

be authorized by this bill. 

H.R. 4080 would authorize the appropriation of $24 million a 

year for 2015 through 2019 for public and private entities that provide trauma and emergency care services and for the administration of FICEMS. The bill also would require states that receive 

grant aid to comply with national standards and requirements for 

designating verified burn centers. Finally, the bill would require 

the Secretary of Health and Human Services to submit a report to 

the Congress on federal and state activities associated with trauma 

and emergency care services. 

Based on historical patterns of spending for similar activities, 

CBO estimates that implementing the bill would cost $101 million 

over the 2015–2019 period, assuming appropriation of the specified 

amounts. 

Pay-As-You-Go considerations: None. 

Intergovernmental and private-sector impact: H.R. 4080 contains 

no intergovernmental or private-sector mandates as defined in 

UMRA. 

Estimate prepared by: Federal Costs: Lisa Ramirez-Branum; Impact on state, local, and tribal governments: J’nell L. Blanco; Impact on the private sector: Alexia Diorio. 

Estimate approved by: Holly Harvey, Deputy Assistant Director 

for Budget Analysis. 

FEDERAL MANDATES STATEMENT

The Committee adopts as its own the estimate of Federal mandates prepared by the Director of the Congressional Budget Office 

pursuant to section 423 of the Unfunded Mandates Reform Act. 


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DUPLICATION OF FEDERAL PROGRAMS

No provision of H.R. 4080 establishes or reauthorizes a program 

of the Federal government known to be duplicative of another Federal program, a program that was included in any report from the 

Government Accountability Office to Congress pursuant to section 

21 of Public Law 111–139, or a program related to a program identified in the most recent Catalog of Federal Domestic Assistance. 

DISCLOSURE OF DIRECTED RULE MAKINGS

The Committee estimates that enacting H.R. 4080 would not specifically direct a rulemaking within the meaning of 5 U.S.C. 551. 

ADVISORY COMMITTEE STATEMENT

No advisory committees within the meaning of section 5(b) of the 

Federal Advisory Committee Act were created by this legislation. 

APPLICABILITY TO LEGISLATIVE BRANCH

The Committee finds that the legislation does not relate to the 

terms and conditions of employment or access to public services or 

accommodations within the meaning of section 102(b)(3) of the Congressional Accountability Act. 

SECTION-BY-SECTION ANALYSIS OF THE LEGISLATION

Section 1. Short title 

Section 1 provides the short title of ‘‘Trauma Systems and Regionalization of Emergency Care Reauthorization Act.’’ 

Section 2. Reauthorization of certain trauma care programs 

Section 2 would amend Section 1232(a) of the PHSA by striking 

‘‘2014’’ and inserting ‘‘2019’’. 

Section 3. Improvements and clarifications to certain trauma care 

programs 

Section 3 would amend Section 1232(c) of the PHSA to clarify the 

division of remaining funds and for States to consider the national 

standards of the American Burn Association for the designation of 

verified burn centers in their plan for the provision of emergency 

medical services. 

CHANGES IN EXISTING LAW MADE BY THE BILL, AS REPORTED

In compliance with clause 3(e) of rule XIII of the Rules of the 

House of Representatives, changes in existing law made by the bill, 

as reported, are shown as follows (existing law proposed to be omitted is enclosed in black brackets, new matter is printed in italic, 

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

PUBLIC HEALTH SERVICE ACT 

* * * * * * * 

TITLE XII—TRAUMA CARE 

* * * * * * * 


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PART B—FORMULA GRANTS WITH RESPECT TO MODIFICATIONS OF

STATE PLANS

* * * * * * * 

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) * * * 

* * * * * * * 

(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, and (for a fiscal year after fiscal year 2014) contains national standards and requirements of the American Burn Association for the designation of verified burn centers, including 

standards and requirements for— 

(A) * * * 

* * * * * * * 

(b) CERTAIN STANDARDS WITH RESPECT TO TRAUMA CARE CENTERS AND SYSTEMS.— 

(1) * * * 

* * * * * * * 

(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, øand the American Academy of Pediatrics,¿ the 

American Academy of Pediatrics, and (for a fiscal year 

after fiscal year 2014) the American Burn Association, in 

adopting standards under this subsection; or 

* * * * * * * 

(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 and not later than 1 year after the date of 

the enactment of the Trauma Systems and Regionalization of 

Emergency Care Reauthorization Act, 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— 


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(A) take into account national standards, including those 

of the American College of Surgeons, American College of 

Emergency Physicians, øand the American Academy of Pediatrics¿ the American Academy of Pediatrics, and (with 

respect to the update pursuant to the Trauma Systems and 

Regionalization of Emergency Care Reauthorization Act) 

the American Burn Association; 

* * * * * * * 

SEC. 1218. DETERMINATION OF AMOUNT OF ALLOTMENT. 

(a) * * * 

* * * * * * * 

(c) DISPOSITION OF CERTAIN FUNDS APPROPRIATED FOR ALLOTMENTS.— 

(1) * * * 

(2) TYPE OF AMOUNTS.—The amounts referred to in paragraph (1) are any amounts made available pursuant to 

ø1232(b)(3)¿ section 1232(b) that are not paid under section 

1211(a) to a State as a result of— 

(A) * * * 

* * * * * * * 

SEC. 1222. REPORT BY SECRETARY. 

Not later than øOctober 1, 2008¿ October 1, 2016, 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. 

PART C—GENERAL PROVISIONS REGARDING PARTS A AND B 

* * * * * * * 

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 $24,000,000 for each of fiscal 

years 2010 through ø2014¿ 2019. 

* * * * * * * 

(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; øand¿ 

(2) 10 percent of such amounts for such year shall be allocated for the purpose of carrying out section 1202ø.¿; and 

(3) for a fiscal year after fiscal year 2014, not more than 50 

percent of such amounts remaining for such fiscal year after apVerDate Mar 15 2010 21:16 May 23, 2014 Jkt 039006 PO 00000 Frm 00008 Fmt 6659 Sfmt 6603 E:\HR\OC\HR459.XXX HR459

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plication of paragraphs (1) and (2) shall be allocated for the 

purpose of carrying out section 1204. 

* * * * * * * 

Æ 


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