H. R. 248

One Hundred Fourth Congress

of the

United States of America

AT THE SECOND SESSION

Begun and held at the City of Washington on Wednesday,

the third day of January, one thousand nine hundred and ninety-six

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.

Be it enacted by the Senate and House of Representatives of

the United States of America in Congress assembled,

SECTION 1. PROGRAMS OF CENTERS FOR DISEASE CONTROL AND

PREVENTION.

Part J of title III of the Public Health Service Act (42 U.S.C.

280b et seq.) is amended by inserting after section 393 the following

section:

‘‘PREVENTION OF TRAUMATIC BRAIN INJURY

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

the Director of the Centers for Disease Control and Prevention,

may carry out projects to reduce the incidence of traumatic brain

injury. Such projects may be carried out by the Secretary directly

or through awards of grants or contracts to public or nonprofit

private entities. The Secretary may directly or through such awards

provide technical assistance with respect to the planning, development, and operation of such projects.

‘‘(b) CERTAIN ACTIVITIES.—Activities under subsection (a) may

include—

‘‘(1) the conduct of research into identifying effective strategies for the prevention of traumatic brain injury; and

‘‘(2) the implementation of public information and education

programs for the prevention of such injury and for broadening

the awareness of the public concerning the public health consequences of such injury.

‘‘(c) COORDINATION OF ACTIVITIES.—The Secretary shall ensure

that activities under this section are coordinated as appropriate

with other agencies of the Public Health Service that carry out

activities regarding traumatic brain injury.

‘‘(d) 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 near drowning. The Secretary

may revise the definition of such term as the Secretary determines

necessary.’’.

SEC. 2. PROGRAMS OF NATIONAL INSTITUTES OF HEALTH.

Section 1261 of the Public Health Service Act (42 U.S.C. 300d–

61) is amended—
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(1) in subsection (d)—

(A) in paragraph (2), by striking ‘‘and’’ after the semicolon at the end;

(B) in paragraph (3), by striking the period and inserting ‘‘; and’’; and

(C) by adding at the end the following paragraph:

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

to public or nonprofit private entities for the conduct of basic

and applied research regarding traumatic brain injury, which

research may include—

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

for the more effective diagnosis, measurement of degree

of injury, post-injury monitoring and prognostic assessment

of head injury for acute, subacute and later phases of

care;

‘‘(B) the development, modification and evaluation of

therapies that retard, prevent or reverse brain damage

after acute head injury, that arrest further deterioration

following injury and that provide the restitution of function

for individuals with long-term injuries;

‘‘(C) the development of research on a continuum of

care from acute care through rehabilitation, designed, to

the extent practicable, to integrate rehabilitation and longterm outcome evaluation with acute care research; and

‘‘(D) the development of programs that increase the

participation of academic centers of excellence in head

injury treatment and rehabilitation research and training.’’;

and

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

paragraph:

‘‘(4) 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.’’.

SEC. 3. PROGRAMS OF HEALTH RESOURCES AND SERVICES ADMINISTRATION.

Part E of title XII of the Public Health Service Act (42 U.S.C.

300d–51 et seq.) is amended by adding at the end the following

section:

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

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

make grants to States for the purpose of carrying out demonstration

projects to improve access to health 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 State involved agrees to establish

an advisory board within the appropriate health department

of the State or within another department as designated by

the chief executive officer of the State.

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

paragraph (1) shall advise and make recommendations to the
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State 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 State agencies involved;

‘‘(ii) public and nonprofit private health related

organizations;

‘‘(iii) other disability advisory or planning groups

within the State;

‘‘(iv) members of an organization or foundation

representing traumatic brain injury survivors in that

State; and

‘‘(v) injury control programs at the State or local

level if such programs exist; and

‘‘(B) a substantial number of individuals who are survivors of traumatic brain injury, or the family members

of such individuals.

‘‘(c) MATCHING FUNDS.—

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

by a State in carrying out the purpose described in subsection

(a), the Secretary may make a grant under such subsection

only if the State agrees to make available, in cash, non-Federal

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.—In determining the amount of non-Federal contributions in cash that

a State has provided pursuant to paragraph (1), the Secretary

may not include any amounts provided to the State by the

Federal Government.

‘‘(d) APPLICATION FOR GRANT.—The Secretary may make a grant

under subsection (a) only if an application for the grant is submitted

to the Secretary and the application is in such form, is made

in such manner, and contains such agreements, assurances, and

information as the Secretary determines to be necessary to carry

out this section.

‘‘(e) COORDINATION OF ACTIVITIES.—The Secretary shall ensure

that activities under this section are coordinated as appropriate

with other agencies of the Public Health Service that carry out

activities regarding traumatic brain injury.

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

enactment of this section, 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, including measures of outcomes and consumer

and surrogate satisfaction.

‘‘(g) 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 near drowning. The Secretary
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may revise the definition of such term as the Secretary determines

necessary.

‘‘(h) AUTHORIZATION OF APPROPRIATIONS.—For the purpose of

carrying out this section, there is authorized to be appropriated

$5,000,000 for each of the fiscal years 1997 through 1999.’’.

SEC. 4. STUDY; CONSENSUS CONFERENCE.

(a) STUDY.—

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

Services (in this section referred to as the ‘‘Secretary’’), acting

through the appropriate agencies of the Public Health Service,

shall conduct a study for the purpose of carrying out the following with respect to traumatic brain injury:

(A) In collaboration with appropriate State and local

health-related agencies—

(i) determine the incidence and prevalence of traumatic brain injury; and

(ii) develop a uniform reporting system under

which States report incidents of traumatic brain injury,

if the Secretary determines that such a system is

appropriate.

(B) Identify common therapeutic interventions which

are used for the rehabilitation of individuals with such

injuries, and shall, subject to the availability of information,

include an analysis of—

(i) the effectiveness of each such intervention in

improving the functioning of individuals with brain

injuries;

(ii) 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

(iii) the adequacy of existing measures of outcomes

and knowledge of factors influencing differential outcomes.

(C) Develop practice guidelines for the rehabilitation

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

(2) DATES CERTAIN FOR REPORTS.—

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

enactment of this Act, 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 made as

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

(B) Not later than 3 years after the date of the enactment of this Act, the Secretary shall submit to the Committees specified in subparagraph (A) a report describing the

findings made as a result of carrying out subparagraphs

(B) and (C) of paragraph (1).
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(b) CONSENSUS CONFERENCE.—The Secretary, acting through

the Director of the National Center for Medical Rehabilitation

Research within the National Institute for Child Health and Human

Development, shall conduct a national consensus conference on

managing traumatic brain injury and related rehabilitation concerns.

(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 near drowning. The Secretary

may revise the definition of such term as the Secretary determines

necessary.

(d) AUTHORIZATIONS OF APPROPRIATIONS.—For the purpose of

carrying out subsection (a)(1)(A), there is authorized to be appropriated $3,000,000 for each of the fiscal years 1997 through 1999.

For the purpose of carrying out the other provisions of this section,

there is authorized to be appropriated an aggregate $500,000 for

the fiscal years 1997 through 1999. Amounts appropriated for such

other provisions remain available until expended.

SEC. 5. TECHNICAL AMENDMENTS.

Title XXVI of the Public Health Service Act (42 U.S.C. 300ff–

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

CARE Act Amendments of 1996), is amended—

(1) in section 2626—

(A) in subsection (d), in the first sentence, by striking

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

(B) in subsection (f), in the matter preceding paragraph

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

(4)’’; and

(2) in section 2692—

(A) in subsection (a)(1)(A)—

(i) by striking ‘‘title XXVI programs’’ and inserting

‘‘programs under this title’’; and

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

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

inserting the following:
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‘‘(c) AUTHORIZATION OF APPROPRIATIONS.—

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

subsection (a), there are authorized to be appropriated such

sums as may be necessary for each of the fiscal years 1996

through 2000.

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

subsection (b), there are authorized to be appropriated such

sums as may be necessary for each of the fiscal years 1996

through 2000.’’.

Speaker of the House of Representatives.

Vice President of the United States and

President of the Senate.