II

104TH CONGRESS

2D SESSION H. R. 248

IN THE SENATE OF THE UNITED STATES

JULY 10, 1996

Received

AN ACT

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,
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1 SECTION 1. PROGRAMS OF CENTERS FOR DISEASE CON2 TROL AND PREVENTION.

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

4 (42 U.S.C. 280b et seq.) is amended by inserting after

5 section 393 the following section:

6 ‘‘PREVENTION OF TRAUMATIC BRAIN INJURY

7 ‘‘SEC. 393A. (a) IN GENERAL.—The Secretary, act8 ing through the Director of the Centers for Disease Con9 trol and Prevention, may carry out projects to reduce the

10 incidence of traumatic brain injury. Such projects may be

11 carried out by the Secretary directly or through awards

12 of grants or contracts to public or nonprofit private enti13 ties. The Secretary may directly or through such awards

14 provide technical assistance with respect to the planning,

15 development, and operation of such projects.

16 ‘‘(b) CERTAIN ACTIVITIES.—Activities under sub17 section (a) may include—

18 ‘‘(1) the conduct of research into identifying ef19 fective strategies for the prevention of traumatic

20 brain injury; and

21 ‘‘(2) the implementation of public information

22 and education programs for the prevention of such

23 injury and for broadening the awareness of the pub24 lic concerning the public health consequences of such

25 injury.
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1 ‘‘(c) COORDINATION OF ACTIVITIES.—The Secretary

2 shall ensure that activities under this section are coordi3 nated as appropriate with other agencies of the Public

4 Health Service that carry out activities regarding trau5 matic brain injury.

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

7 term ‘traumatic brain injury’ means an acquired injury

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

9 caused by congenital or degenerative disorders, nor birth

10 trauma, but may include brain injuries caused by anoxia

11 due to near drowning. The Secretary may revise the defi12 nition of such term as the Secretary determines

13 necessary.’’.

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

15 Section 1261 of the Public Health Service Act (42

16 U.S.C. 300d–61) is amended—

17 (1) in subsection (d)—

18 (A) in paragraph (2), by striking ‘‘and’’

19 after the semicolon at the end;

20 (B) in paragraph (3), by striking the pe21 riod and inserting ‘‘; and’’; and

22 (C) by adding at the end the following

23 paragraph:

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

25 contracts to public or nonprofit private entities for
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1 the conduct of basic and applied research regarding

2 traumatic brain injury, which research may in3 clude—

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

5 modalities for the more effective diagnosis,

6 measurement of degree of injury, post-injury

7 monitoring and prognostic assessment of head

8 injury for acute, subacute and later phases of

9 care;

10 ‘‘(B) the development, modification and

11 evaluation of therapies that retard, prevent or

12 reverse brain damage after acute head injury,

13 that arrest further deterioration following in14 jury and that provide the restitution of function

15 for individuals with long-term injuries;

16 ‘‘(C) the development of research on a con17 tinuum of care from acute care through reha18 bilitation, designed, to the extent practicable, to

19 integrate rehabilitation and long-term outcome

20 evaluation with acute care research; and

21 ‘‘(D) the development of programs that in22 crease the participation of academic centers of

23 excellence in head injury treatment and reha24 bilitation research and training.’’; and
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1 (2) in subsection (h), by adding at the end the

2 following paragraph:

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

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

5 include brain dysfunction caused by congenital or

6 degenerative disorders, nor birth trauma, but may

7 include brain injuries caused by anoxia due to near

8 drowning. The Secretary may revise the definition of

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

10 SEC. 3. PROGRAMS OF HEALTH RESOURCES AND SERVICES

11 ADMINISTRATION.

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

13 (42 U.S.C. 300d–51 et seq.) is amended by adding at the

14 end the following section:

15 ‘‘SEC. 1252. STATE GRANTS FOR DEMONSTRATION

16 PROJECTS REGARDING TRAUMATIC BRAIN

17 INJURY.

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

19 the Administrator of the Health Resources and Services

20 Administration, may make grants to States for the pur21 pose of carrying out demonstration projects to improve ac22 cess to health and other services regarding traumatic

23 brain injury.

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

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

3 agrees to establish an advisory board within the ap4 propriate health department of the State or within

5 another department as designated by the chief exec6 utive officer of the State.

7 ‘‘(2) FUNCTIONS.—An advisory board estab8 lished under paragraph (1) shall advise and make

9 recommendations to the State on ways to improve

10 services coordination regarding traumatic brain in11 jury. Such advisory boards shall encourage citizen

12 participation through the establishment of public

13 hearings and other types of community outreach

14 programs. In developing recommendations under this

15 paragraph, such boards shall consult with Federal,

16 State, and local governmental agencies and with citi17 zens groups and other private entities.

18 ‘‘(3) COMPOSITION.—An advisory board estab19 lished under paragraph (1) shall be composed of—

20 ‘‘(A) representatives of—

21 ‘‘(i) the corresponding State agencies

22 involved;

23 ‘‘(ii) public and nonprofit private

24 health related organizations;
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1 ‘‘(iii) other disability advisory or plan2 ning groups within the State;

3 ‘‘(iv) members of an organization or

4 foundation representing traumatic brain

5 injury survivors in that State; and

6 ‘‘(v) injury control programs at the

7 State or local level if such programs exist;

8 and

9 ‘‘(B) a substantial number of individuals

10 who are survivors of traumatic brain injury, or

11 the family members of such individuals.

12 ‘‘(c) MATCHING FUNDS.—

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

14 be incurred by a State in carrying out the purpose

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

16 a grant under such subsection only if the State

17 agrees to make available, in cash, non-Federal con18 tributions toward such costs in an amount that is

19 not less than $1 for each $2 of Federal funds pro20 vided under the grant.

21 ‘‘(2) DETERMINATION OF AMOUNT CONTRIB22 UTED.—In determining the amount of non-Federal

23 contributions in cash that a State has provided pur24 suant to paragraph (1), the Secretary may not in-
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1 clude any amounts provided to the State by the Fed2 eral Government.

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

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

5 for the grant is submitted to the Secretary and the appli6 cation is in such form, is made in such manner, and con7 tains such agreements, assurances, and information as the

8 Secretary determines to be necessary to carry out this sec9 tion.

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

11 shall ensure that activities under this section are coordi12 nated as appropriate with other agencies of the Public

13 Health Service that carry out activities regarding trau14 matic brain injury.

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

16 of the enactment of this section, the Secretary shall sub17 mit to the Committee on Commerce of the House of Rep18 resentatives, and to the Committee on Labor and Human

19 Resources of the Senate, a report describing the findings

20 and results of the programs established under this section,

21 including measures of outcomes and consumer and surro22 gate satisfaction.

23 ‘‘(g) DEFINITION.—For purposes of this section, the

24 term ‘traumatic brain injury’ means an acquired injury

25 to the brain. Such term does not include brain dysfunction
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1 caused by congenital or degenerative disorders, nor birth

2 trauma, but may include brain injuries caused by anoxia

3 due to near drowning. The Secretary may revise the defi4 nition of such term as the Secretary determines necessary.

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

6 purpose of carrying out this section, there is authorized

7 to be appropriated $5,000,000 for each of the fiscal years

8 1997 through 1999.’’.

9 SEC. 4. STUDY; CONSENSUS CONFERENCE.

10 (a) STUDY.—

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

12 Human Services (in this section referred to as the

13 ‘‘Secretary’’), acting through the appropriate agen14 cies of the Public Health Service, shall conduct a

15 study for the purpose of carrying out the following

16 with respect to traumatic brain injury:

17 (A) In collaboration with appropriate State

18 and local health-related agencies—

19 (i) determine the incidence and preva20 lence of traumatic brain injury; and

21 (ii) develop a uniform reporting sys22 tem under which States report incidents of

23 traumatic brain injury, if the Secretary de24 termines that such a system is appropriate.
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1 (B) Identify common therapeutic interven2 tions which are used for the rehabilitation of in3 dividuals with such injuries, and shall, subject

4 to the availability of information, include an

5 analysis of—

6 (i) the effectiveness of each such

7 intervention in improving the functioning

8 of individuals with brain injuries;

9 (ii) the comparative effectiveness of

10 interventions employed in the course of re11 habilitation of individuals with brain inju12 ries to achieve the same or similar clinical

13 outcome; and

14 (iii) the adequacy of existing measures

15 of outcomes and knowledge of factors in16 fluencing differential outcomes.

17 (C) Develop practice guidelines for the re18 habilitation of traumatic brain injury at such

19 time as appropriate scientific research becomes

20 available.

21 (2) DATES CERTAIN FOR REPORTS.—

22 (A) Not later than 18 months after the

23 date of the enactment of this Act, the Secretary

24 shall submit to the Committee on Commerce of

25 the House of Representatives, and to the Com-
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1 mittee on Labor and Human Resources of the

2 Senate, a report describing the findings made

3 as a result of carrying out paragraph (1)(A).

4 (B) Not later than 3 years after the date

5 of the enactment of this Act, the Secretary shall

6 submit to the Committees specified in subpara7 graph (A) a report describing the findings made

8 as a result of carrying out subparagraphs (B)

9 and (C) of paragraph (1).

10 (b) CONSENSUS CONFERENCE.—The Secretary, act11 ing through the Director of the National Center for Medi12 cal Rehabilitation Research within the National Institute

13 for Child Health and Human Development, shall conduct

14 a national consensus conference on managing traumatic

15 brain injury and related rehabilitation concerns.

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

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

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

19 caused by congenital or degenerative disorders, nor birth

20 trauma, but may include brain injuries caused by anoxia

21 due to near drowning. The Secretary may revise the defi22 nition of such term as the Secretary determines necessary.

23 (d) AUTHORIZATIONS OF APPROPRIATIONS.—For the

24 purpose of carrying out subsection (a)(1)(A), there is au25 thorized to be appropriated $3,000,000 for each of the fis-
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1 cal years 1997 through 1999. For the purpose of carrying

2 out the other provisions of this section, there is authorized

3 to be appropriated an aggregate $500,000 for the fiscal

4 years 1997 through 1999. Amounts appropriated for such

5 other provisions remain available until expended.

6 SEC. 5. TECHNICAL AMENDMENTS.

7 Title XXVI of the Public Health Service Act (42

8 U.S.C. 300ff–11 et seq.), as amended by Public Law 104–

9 146 (the Ryan White CARE Act Amendments of 1996),

10 is amended—

11 (1) in section 2626—

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

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

14 ‘‘(1) through (4)’’; and

15 (B) in subsection (f), in the matter preced16 ing paragraph (1), by striking ‘‘(1) through

17 (5)’’ and inserting ‘‘(1) through (4)’’; and

18 (2) in section 2692—

19 (A) in subsection (a)(1)(A)—

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

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

22 and

23 (ii) by striking ‘‘infection and’’; and

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

25 follows and inserting the following:
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1 ‘‘(c) AUTHORIZATION OF APPROPRIATIONS.—

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

3 grants under subsection (a), there are authorized to

4 be appropriated such sums as may be necessary for

5 each of the fiscal years 1996 through 2000.

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

7 grants under subsection (b), there are authorized to

8 be appropriated such sums as may be necessary for

9 each of the fiscal years 1996 through 2000.’’.

Passed the House of Representatives July 9, 1996.

Attest: ROBIN H. CARLE,

Clerk.