Union Calendar No. 331

104TH CONGRESS

2D SESSION H. R. 248

[Report No. 104–652]

A BILL

To amend the Public Health Service Act to provide

poses.to traumatic brain injury, and for other purtablishment of innovative programs with respectfor the conduct of expanded studies and the esJUNE 27, 1996

Reported with an amendment, committed to the Commitordered to be printed tee of the Whole House on the State of the Union, and
IB

Union Calendar No. 331

104TH CONGRESS

2D SESSION H. R. 248

[Report No. 104–652]

To amend the Public Health Service Act to provide for the conduct of

expanded studies and the establishment of innovative programs with

respect to traumatic brain injury, and for other purposes.

IN THE HOUSE OF REPRESENTATIVES

JANUARY 4, 1995

Mr. GREENWOOD (for himself and Mr. PALLONE) introduced the following bill;

which was referred to the Committee on Commerce

JUNE 27, 1996

Additional sponsors: Ms. LOFGREN, Mr. GEJDENSON, Mr. EHLERS, Mr.

HUTCHINSON, Mr. SERRANO, Mr. LEWIS of Georgia, Mr. QUILLEN, Mr.

DAVIS, Mr. SMITH of New Jersey, Mr. FOLEY, Mr. MINETA, Mr.

STUDDS, Mr. WATTS of Oklahoma, Mr. BEILENSON, Mr. FRAZER, Mr.

ENGLISH of Pennsylvania, Mr. BOUCHER, Mr. BALDACCI, Mr. LIPINSKI,

Mr. WAXMAN, Mr. ACKERMAN, Mrs. MORELLA, Mr. HAMILTON, Mr.

STARK, Mr. STEARNS, Mr. LEACH, Mr. MORAN, Ms. NORTON, Ms.

ESHOO, Mr. GUTIERREZ, Mr. UPTON, Mr. THORNBERRY, Mr. FRANK of

Massachusetts, and Mr. HOBSON

JUNE 27, 1996

Reported with an amendment, committed to the Committee of the Whole

House on the State of the Union, and ordered to be printed

[Strike out all after the enacting clause and insert the part printed in italic]

[For text of introduced bill, see copy of bill as introduced on January 4, 1995]
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A BILL

To amend the Public Health Service Act to provide for

the conduct of expanded studies and the establishment

of innovative programs with respect to traumatic brain

injury, and for other purposes.

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled,

3 SECTION 1. PROGRAMS OF CENTERS FOR DISEASE CON4 TROL AND PREVENTION.

5 Part J of title III of the Public Health Service Act

6 (42 U.S.C. 280b et seq.) is amended by inserting after sec7 tion 393 the following section:

8 ‘‘PREVENTION OF TRAUMATIC BRAIN INJURY

9 ‘‘SEC. 393A. (a) IN GENERAL.—The Secretary, acting

10 through the Director of the Centers for Disease Control and

11 Prevention, may carry out projects to reduce the incidence

12 of traumatic brain injury. Such projects may be carried

13 out by the Secretary directly or through awards of grants

14 or contracts to public or nonprofit private entities. The Sec15 retary may directly or through such awards provide tech16 nical assistance with respect to the planning, development,

17 and operation of such projects.

18 ‘‘(b) CERTAIN ACTIVITIES.—Activities under sub19 section (a) may include—
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1 ‘‘(1) the conduct of research into identifying ef2 fective strategies for the prevention of traumatic brain

3 injury; and

4 ‘‘(2) the implementation of public information

5 and education programs for the prevention of such in6 jury and for broadening the awareness of the public

7 concerning the public health consequences of such in8 jury.

9 ‘‘(c) COORDINATION OF ACTIVITIES.—The Secretary

10 shall ensure that activities under this section are coordi11 nated as appropriate with other agencies of the Public

12 Health Service that carry out activities regarding trau13 matic brain injury.

14 ‘‘(d) DEFINITION.—For purposes of this section, the

15 term ‘traumatic brain injury’ means an acquired injury

16 to the brain. Such term does not include brain dysfunction

17 caused by congenital or degenerative disorders, nor birth

18 trauma, but may include brain injuries caused by anoxia

19 due to near drowning. The Secretary may revise the defini20 tion of such term as the Secretary determines necessary.’’.

21 SEC. 2. PROGRAMS OF NATIONAL INSTITUTES OF HEALTH.

22 Section 1261 of the Public Health Service Act (42

23 U.S.C. 300d–61) is amended—

24 (1) in subsection (d)—
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1 (A) in paragraph (2), by striking ‘‘and’’

2 after the semicolon at the end;

3 (B) in paragraph (3), by striking the period

4 and inserting ‘‘; and’’; and

5 (C) by adding at the end the following

6 paragraph:

7 ‘‘(4) the authority to make awards of grants or

8 contracts to public or nonprofit private entities for

9 the conduct of basic and applied research regarding

10 traumatic brain injury, which research may in11 clude—

12 ‘‘(A) the development of new methods and

13 modalities for the more effective diagnosis, meas14 urement of degree of injury, post-injury monitor15 ing and prognostic assessment of head injury for

16 acute, subacute and later phases of care;

17 ‘‘(B) the development, modification and

18 evaluation of therapies that retard, prevent or

19 reverse brain damage after acute head injury,

20 that arrest further deterioration following injury

21 and that provide the restitution of function for

22 individuals with long-term injuries;

23 ‘‘(C) the development of research on a con24 tinuum of care from acute care through rehabili25 tation, designed, to the extent practicable, to in-
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1 tegrate rehabilitation and long-term outcome

2 evaluation with acute care research; and

3 ‘‘(D) the development of programs that in4 crease the participation of academic centers of

5 excellence in head injury treatment and rehabili6 tation research and training.’’; and

7 (2) in subsection (h), by adding at the end the

8 following paragraph:

9 ‘‘(4) The term ‘traumatic brain injury’ means

10 an acquired injury to the brain. Such term does not

11 include brain dysfunction caused by congenital or de12 generative disorders, nor birth trauma, but may in13 clude brain injuries caused by anoxia due to near

14 drowning. The Secretary may revise the definition of

15 such term as the Secretary determines necessary.’’.

16 SEC. 3. PROGRAMS OF HEALTH RESOURCES AND SERVICES

17 ADMINISTRATION.

18 Part E of title XII of the Public Health Service Act

19 (42 U.S.C. 300d–51 et seq.) is amended by adding at the

20 end the following section:

21 ‘‘SEC. 1252. STATE GRANTS FOR DEMONSTRATION

22 PROJECTS REGARDING TRAUMATIC BRAIN

23 INJURY.

24 ‘‘(a) IN GENERAL.—The Secretary, acting through the

25 Administrator of the Health Resources and Services Admin-
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1 istration, may make grants to States for the purpose of car2 rying out demonstration projects to improve access to health

3 and other services regarding traumatic brain injury.

4 ‘‘(b) STATE ADVISORY BOARD.—

5 ‘‘(1) IN GENERAL.—The Secretary may make a

6 grant under subsection (a) only if the State involved

7 agrees to establish an advisory board within the ap8 propriate health department of the State or within

9 another department as designated by the chief execu10 tive officer of the State.

11 ‘‘(2) FUNCTIONS.—An advisory board established

12 under paragraph (1) shall advise and make rec13 ommendations to the State on ways to improve serv14 ices coordination regarding traumatic brain injury.

15 Such advisory boards shall encourage citizen partici16 pation through the establishment of public hearings

17 and other types of community outreach programs. In

18 developing recommendations under this paragraph,

19 such boards shall consult with Federal, State, and

20 local governmental agencies and with citizens groups

21 and other private entities.

22 ‘‘(3) COMPOSITION.—An advisory board estab23 lished under paragraph (1) shall be composed of—

24 ‘‘(A) representatives of—
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1 ‘‘(i) the corresponding State agencies

2 involved;

3 ‘‘(ii) public and nonprofit private

4 health related organizations;

5 ‘‘(iii) other disability advisory or

6 planning groups within the State;

7 ‘‘(iv) members of an organization or

8 foundation representing traumatic brain in9 jury survivors in that State; and

10 ‘‘(v) injury control programs at the

11 State or local level if such programs exist;

12 and

13 ‘‘(B) a substantial number of individuals

14 who are survivors of traumatic brain injury, or

15 the family members of such individuals.

16 ‘‘(c) MATCHING FUNDS.—

17 ‘‘(1) IN GENERAL.—With respect to the costs to

18 be incurred by a State in carrying out the purpose

19 described in subsection (a), the Secretary may make

20 a grant under such subsection only if the State agrees

21 to make available, in cash, non-Federal contributions

22 toward such costs in an amount that is not less than

23 $1 for each $2 of Federal funds provided under the

24 grant.
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1 ‘‘(2) DETERMINATION OF AMOUNT CONTRIB2 UTED.—In determining the amount of non-Federal

3 contributions in cash that a State has provided pur4 suant to paragraph (1), the Secretary may not in5 clude any amounts provided to the State by the Fed6 eral Government.

7 ‘‘(d) APPLICATION FOR GRANT.—The Secretary may

8 make a grant under subsection (a) only if an application

9 for the grant is submitted to the Secretary and the applica10 tion is in such form, is made in such manner, and contains

11 such agreements, assurances, and information as the Sec12 retary determines to be necessary to carry out this section.

13 ‘‘(e) COORDINATION OF ACTIVITIES.—The Secretary

14 shall ensure that activities under this section are coordi15 nated as appropriate with other agencies of the Public

16 Health Service that carry out activities regarding trau17 matic brain injury.

18 ‘‘(f) REPORT.—Not later than 2 years after the date

19 of the enactment of this section, the Secretary shall submit

20 to the Committee on Commerce of the House of Representa21 tives, and to the Committee on Labor and Human Re22 sources of the Senate, a report describing the findings and

23 results of the programs established under this section, in24 cluding measures of outcomes and consumer and surrogate

25 satisfaction.
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1 ‘‘(g) DEFINITION.—For purposes of this section, the

2 term ‘traumatic brain injury’ means an acquired injury

3 to the brain. Such term does not include brain dysfunction

4 caused by congenital or degenerative disorders, nor birth

5 trauma, but may include brain injuries caused by anoxia

6 due to near drowning. The Secretary may revise the defini7 tion of such term as the Secretary determines necessary.

8 ‘‘(h) AUTHORIZATION OF APPROPRIATIONS.—For the

9 purpose of carrying out this section, there is authorized to

10 be appropriated $5,000,000 for each of the fiscal years 1997

11 through 1999.’’.

12 SEC. 4. STUDY; CONSENSUS CONFERENCE.

13 (a) STUDY.—

14 (1) IN GENERAL.—The Secretary of Health and

15 Human Services (in this section referred to as the

16 ‘‘Secretary’’), acting through the appropriate agencies

17 of the Public Health Service, shall conduct a study for

18 the purpose of carrying out the following with respect

19 to traumatic brain injury:

20 (A) In collaboration with appropriate State

21 and local health-related agencies—

22 (i) determine the incidence and preva23 lence of traumatic brain injury; and

24 (ii) develop a uniform reporting sys25 tem under which States report incidents of
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1 traumatic brain injury, if the Secretary de2 termines that such a system is appropriate.

3 (B) Identify common therapeutic interven4 tions which are used for the rehabilitation of in5 dividuals with such injuries, and shall, subject to

6 the availability of information, include an anal7 ysis of—

8 (i) the effectiveness of each such inter9 vention in improving the functioning of in10 dividuals with brain injuries;

11 (ii) the comparative effectiveness of

12 interventions employed in the course of re13 habilitation of individuals with brain inju14 ries to achieve the same or similar clinical

15 outcome; and

16 (iii) the adequacy of existing measures

17 of outcomes and knowledge of factors influ18 encing differential outcomes.

19 (C) Develop practice guidelines for the reha20 bilitation of traumatic brain injury at such time

21 as appropriate scientific research becomes avail22 able.

23 (2) DATES CERTAIN FOR REPORTS.—

24 (A) Not later than 18 months after the date

25 of the enactment of this Act, the Secretary shall
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1 submit to the Committee on Commerce of the

2 House of Representatives, and to the Committee

3 on Labor and Human Resources of the Senate,

4 a report describing the findings made as a result

5 of carrying out paragraph (1)(A).

6 (B) Not later than 3 years after the date of

7 the enactment of this Act, the Secretary shall

8 submit to the Committees specified in subpara9 graph (A) a report describing the findings made

10 as a result of carrying out subparagraphs (B)

11 and (C) of paragraph (1).

12 (b) CONSENSUS CONFERENCE.—The Secretary, acting

13 through the Director of the National Center for Medical Re14 habilitation Research within the National Institute for

15 Child Health and Human Development, shall conduct a na16 tional consensus conference on managing traumatic brain

17 injury and related rehabilitation concerns.

18 (c) DEFINITION.—For purposes of this section, the

19 term ‘‘traumatic brain injury’’ means an acquired injury

20 to the brain. Such term does not include brain dysfunction

21 caused by congenital or degenerative disorders, nor birth

22 trauma, but may include brain injuries caused by anoxia

23 due to near drowning. The Secretary may revise the defini24 tion of such term as the Secretary determines necessary.
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1 (d) AUTHORIZATIONS OF APPROPRIATIONS.—For the

2 purpose of carrying out subsection (a)(1)(A), there is au3 thorized to be appropriated $3,000,000 for each of the fiscal

4 years 1997 through 1999. For the purpose of carrying out

5 the other provisions of this section, there is authorized to

6 be appropriated an aggregate $500,000 for the fiscal years

7 1997 through 1999. Amounts appropriated for such other

8 provisions remain available until expended.

9 SEC. 5. TECHNICAL AMENDMENTS.

10 Title XXVI of the Public Health Service Act (42 U.S.C.

11 300ff–11 et seq.), as amended by Public Law 104–146 (the

12 Ryan White CARE Act Amendments of 1996), is amend13 ed—

14 (1) in section 2626—

15 (A) in subsection (d), in the first sentence,

16 by striking ‘‘(1) through (5)’’ and inserting ‘‘(1)

17 through (4)’’; and

18 (B) in subsection (f), in the matter preced19 ing paragraph (1), by striking ‘‘(1) through (5)’’

20 and inserting ‘‘(1) through (4)’’; and

21 (2) in section 2692—

22 (A) in subsection (a)(1)(A)—

23 (i) by striking ‘‘title XXVI programs’’

24 and inserting ‘‘programs under this title’’;

25 and
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1 (ii) by striking ‘‘infection and’’; and

2 (B) by striking subsection (c) and all that

3 follows and inserting the following:

4 ‘‘(c) AUTHORIZATION OF APPROPRIATIONS.—

5 ‘‘(1) SCHOOLS; CENTERS.—For the purpose of

6 grants under subsection (a), there are authorized to be

7 appropriated such sums as may be necessary for each

8 of the fiscal years 1996 through 2000.

9 ‘‘(2) DENTAL SCHOOLS.—For the purpose of

10 grants under subsection (b), there are authorized to be

11 appropriated such sums as may be necessary for each

12 of the fiscal years 1996 through 2000.’’.