I

104TH CONGRESS

1ST SESSION H. R. 248

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

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 B of title III of the Public Health Service Act

6 (42 U.S.C. 241 et seq.), as amended by section 703 of

7 Public Law 103–183 (107 Stat. 2240), is amended by in8 serting after section 317F the following section:
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1 ‘‘PREVENTION OF TRAUMATIC BRAIN INJURY

2 ‘‘SEC. 317G. The Secretary, acting through the Di3 rector of the Centers for Disease Control and Prevention,

4 may carry out projects to reduce the incidence of trau5 matic brain injury. Such projects may be carried out by

6 the Secretary directly or through awards of grants or con7 tracts to public or nonprofit private entities. The Sec8 retary may directly or through such awards provide tech9 nical assistance with respect to the planning, development,

10 and operation of such projects.

11 ‘‘(b) CERTAIN ACTIVITIES.—Activities under sub12 section (a) may include—

13 ‘‘(1) the conduct of research into identifying ef14 fective strategies for the prevention of traumatic

15 brain injury; and

16 ‘‘(2) the implementation of public information

17 and education programs for the prevention of such

18 injury and for broadening the awareness of the pub19 lic concerning the public health consequences of such

20 injury.

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

22 shall ensure that activities under this section are coordi23 nated as appropriate with other agencies of the Public

24 Health Service that carry out activities regarding trau25 matic brain injury.
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1 ‘‘(d) 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 defi7 nition of such term as the Secretary determines

8 necessary.’’.

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

10 Section 1261 of the Public Health Service Act (42

11 U.S.C. 300d–61) is amended—

12 (1) in subsection (d)—

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

14 after the semicolon at the end;

15 (B) in paragraph (3), by striking the pe16 riod and inserting ‘‘; and’’; and

17 (C) by adding at the end the following

18 paragraph:

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

20 contracts to public or nonprofit private entities for

21 the conduct of basic and applied research regarding

22 traumatic brain injury, which research may in23 clude—

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

25 modalities for the more effective diagnosis,
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1 measurement of degree of injury, post-injury

2 monitoring and prognostic assessment of head

3 injury for acute, subacute and later phases of

4 care;

5 ‘‘(B) the development, modification and

6 evaluation of therapies that retard, prevent or

7 reverse brain damage after acute head injury,

8 that arrest further deterioration following in9 jury and that provide the restitution of function

10 for individuals with long-term injuries;

11 ‘‘(C) the development of research on a con12 tinuum of care from acute care through reha13 bilitation, designed, to the extent practicable, to

14 integrate rehabilitation and long-term outcome

15 evaluation with acute care research; and

16 ‘‘(D) the development of programs that in17 crease the participation of academic centers of

18 excellence in head injury treatment and reha19 bilitation research and training.’’; and

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

21 following paragraph:

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

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

24 include brain dysfunction caused by congenital or

25 degenerative disorders, nor birth trauma, but may
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1 include brain injuries caused by anoxia due to near

2 drowning. The Secretary may revise the definition of

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

4 SEC. 3. PROGRAMS OF HEALTH RESOURCES AND SERVICES

5 ADMINISTRATION.

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

7 (42 U.S.C. 300d–51 et seq.) is amended by adding at the

8 end the following section:

9 ‘‘SEC. 1252. STATE GRANTS FOR DEMONSTRATION

10 PROJECTS REGARDING TRAUMATIC BRAIN

11 INJURY.

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

13 the Administrator of the Health Resources and Services

14 Administration, may make grants to States for the pur15 pose of carrying out demonstration projects to improve ac16 cess to health and other services regarding traumatic

17 brain injury.

18 ‘‘(b) STATE ADVISORY BOARD.—

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

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

21 agrees to establish an advisory board within the ap22 propriate health department of the State or within

23 another department as designated by the chief exec24 utive officer of the State.
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1 ‘‘(2) FUNCTIONS.—An advisory board estab2 lished under paragraph (1) shall advise and make

3 recommendations to the State on ways to improve

4 services coordination regarding traumatic brain in5 jury. Such advisory boards shall encourage citizen

6 participation through the establishment of public

7 hearings and other types of community outreach

8 programs.

9 ‘‘(3) COMPOSITION.—An advisory board estab10 lished under paragraph (1) shall be composed of—

11 ‘‘(A) representatives of—

12 ‘‘(i) the corresponding State agencies

13 involved;

14 ‘‘(ii) public and nonprofit private

15 health related organizations;

16 ‘‘(iii) other disability advisory or plan17 ning groups within the State;

18 ‘‘(iv) members of an organization or

19 foundation representing traumatic brain

20 injury survivors in that State; and

21 ‘‘(v) injury control programs at the

22 State or local level if such programs exist;

23 and
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1 ‘‘(B) a substantial number of individuals

2 who are survivors of traumatic brain injury, or

3 the family members of such individuals.

4 ‘‘(c) MATCHING FUNDS.—

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

6 be incurred by a State in carrying out the purpose

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

8 a grant under such subsection only if the State

9 agrees to make available, in cash, non-Federal con10 tributions toward such costs in an amount that is

11 not less than $1 for each $2 of Federal funds pro12 vided under the grant.

13 ‘‘(2) DETERMINATION OF AMOUNT CONTRIB14 UTED.—In determining the amount of non-Federal

15 contributions in cash that a State has provided pur16 suant to paragraph (1), the Secretary may not in17 clude any amounts provided to the State by the Fed18 eral Government.

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

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

21 for the grant is submitted to the Secretary and the appli22 cation is in such form, is made in such manner, and con23 tains such agreements, assurances, and information as the

24 Secretary determines to be necessary to carry out this

25 section.
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1 ‘‘(e) 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 ‘‘(f) REPORT.—Not later than 2 years after the date

7 of the enactment of this section, the Secretary shall sub8 mit to the Committee on Energy and Commerce of the

9 House of Representatives, and to the Committee on Labor

10 and Human Resources of the Senate, a report describing

11 the findings and results of the programs established under

12 this section, including measures of outcomes and

13 consumer and surrogate satisfaction.

14 ‘‘(g) 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 defi20 nition of such term as the Secretary determines necessary.

21 ‘‘(h) AUTHORIZATION OF APPROPRIATIONS.—There

22 are authorized to be appropriated to carry out this section

23 such sums as may be necessary for each of the fiscal years

24 1995 through 1997.’’.
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1 SEC. 4. STUDY; CONSENSUS CONFERENCE.

2 (a) STUDY.—

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

4 Human Services (in this section referred to as the

5 ‘‘Secretary’’), acting through the appropriate agen6 cies of the Public Health Service, shall conduct a

7 study for the purpose of carrying out the following

8 with respect to traumatic brain injury:

9 (1) In collaboration with appropriate State and

10 local health-related agencies—

11 (A) determine the incidence and prevalence

12 of traumatic brain injury; and

13 (B) develop a uniform reporting system

14 under which States report incidents of trau15 matic brain injury, if the Secretary determines

16 that such a system is appropriate.

17 (2) Identify common therapeutic interventions

18 which are used for the rehabilitation of individuals

19 with such injuries, and shall, subject to the availabil20 ity of information, include an analysis of—

21 (A) the effectiveness of each such interven22 tion in improving the functioning of individuals

23 with brain injuries;

24 (B) the comparative effectiveness of inter25 ventions employed in the course of rehabilita-
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1 tion of individuals with brain injuries to achieve

2 the same or similar clinical outcome; and

3 (C) the adequacy of existing measures of

4 outcomes and knowledge of factors influencing

5 differential outcomes.

6 (3) Develop practice guidelines for the rehabili7 tation of traumatic brain injury at such time as ap8 propriate scientific research becomes available.

9 (2) DATES CERTAIN FOR REPORTS.—

10 (A) Not later than 18 months after the

11 date of the enactment of this Act, the Secretary

12 shall submit to the Committee on Energy and

13 Commerce of the House of Representatives, and

14 to the Committee on Labor and Human Re15 sources of the Senate, a report describing the

16 findings made as a result of carrying out para17 graph (1)(A).

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

19 of the enactment of this Act, the Secretary shall

20 submit to the Committees specified in subpara21 graph (A) a report describing the findings made

22 as a result of carrying out subparagraphs (B)

23 and (C) of paragraph (1).

24 (b) CONSENSUS CONFERENCE.—The Secretary, act25 ing through the Director of the National Center for Medi-
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1 cal Rehabilitation Research within the National Institute

2 for Child Health and Human Development, shall conduct

3 a national consensus conference on managing traumatic

4 brain injury and related rehabilitation concerns.

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

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

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

8 caused by congenital or degenerative disorders, nor birth

9 trauma, but may include brain injuries caused by anoxia

10 due to near drowning. The Secretary may revise the defi11 nition of such term as the Secretary determines necessary.

12 (d) AUTHORIZATION OF APPROPRIATIONS.—There

13 are authorized to be appropriated to carry out this section

14 such sums as may be necessary for each of the fiscal years

15 1995 through 1997.

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