I 

108TH CONGRESS 

1ST SESSION H. R. 3513

To amend the Public Health Service Act to direct the Secretary of Health 

and Human Services to expand and intensify programs with respect 

to research and related activities concerning elder falls, and for other 

purposes. 

IN THE HOUSE OF REPRESENTATIVES 

NOVEMBER 18, 2003

Mr. PALLONE introduced the following bill; which was referred to the 

Committee on Energy and Commerce 

A BILL

To amend the Public Health Service Act to direct the Secretary of Health and Human Services to expand and 

intensify programs with respect to research and related 

activities concerning elder falls, 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. SHORT TITLE. 

4 This Act may be cited as the ‘‘Elder Fall Prevention 

5 Act of 2003’’. 

6 SEC. 2. FINDINGS. 

7 The Congress finds as follows: 
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1 (1) Falls are the leading cause of injury deaths 

2 among people over 65. 

3 (2) By 2030, the population of individuals who 

4 are 65 years of age or older will double. By 2050, 

5 the population of individuals who are 85 years of 

6 age or older will quadruple. 

7 (3) In 2000, falls among elderly individuals ac8 counted for 10,200 deaths and 1,600,000 emergency 

9 department visits. 

10 (4) Sixty percent of fall-related deaths occur 

11 among persons 75 and older. 

12 (5) Twenty-five percent of elderly persons who 

13 sustain a hip fracture die within 1 year. 

14 (6) Hospital admissions for hip fractures 

15 among the elderly have increased from 231,000 ad16 missions in 1988 to 332,000 in 1999. The number 

17 of hip fractures is expected to exceed 500,000 by 

18 2040. 

19 (7) Annually, more than 64,000 individuals who 

20 are over 65 years of age sustain a traumatic brain 

21 injury as a result of a fall. 

22 (8) Annually, 40,000 individuals who are over 

23 65 years of age visit emergency departments with 

24 traumatic brain injuries suffered as a result of a 
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1 fall, of which 16,000 of these individuals are hos2 pitalized and 4,000 of these individuals die. 

3 (9) The rate of fall-induced traumatic brain in4 juries for individuals who are 80 years of age or 

5 older increased by 60 percent from 1989 to 1998. 

6 (10) The estimated total cost for non-fatal 

7 traumatic brain injury-related hospitalizations for 

8 falls in individuals who are 65 years of age or older 

9 is more than $3,250,000,000. Two-thirds of these 

10 costs occurred among individual who were 75 years 

11 of age or older. 

12 (11) The costs to the Medicare and Medicaid 

13 programs and society as a whole from falls by elder14 ly persons continue to climb much faster than infla15 tion and population growth. Direct costs alone will 

16 exceed $32,000,000,000 in 2020. 

17 (12) The Federal Government should devote ad18 ditional resources to research regarding the preven19 tion and treatment of falls in residential as well as 

20 institutional settings. 

21 (13) A national approach to reducing elder 

22 falls, which focuses on the daily life of senior citizens 

23 in residential, institutional, and community settings 

24 is needed. The approach should include a wide range 

25 of organizations and individuals including family 
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1 members, health care providers, social workers, ar2 chitects, employers and others. 

3 (14) Reducing preventable adverse events, such 

4 as elder falls, is an important aspect to the agenda 

5 to improve patient safety. 

6 SEC. 3. PURPOSES. 

7 The purposes of this Act are—

8 (1) to develop effective public education strate9 gies in a national initiative to reduce elder falls in 

10 order to educate the elders themselves, family mem11 bers, employers, caregivers, and others who touch 

12 the lives of senior citizens; 

13 (2) to expand needed services and gain informa14 tion about the most effective approaches to pre15 venting and treating elder falls; and 

16 (3) to require the Secretary of Health and 

17 Human Services to evaluate the effect of elder falls 

18 on the costs of the Medicare and Medicaid programs 

19 and the potential for reducing costs by expanding 

20 education, prevention, and elderly intervention serv21 ices covered or sponsored by these two programs. 

22 SEC. 4. AMENDMENT TO PUBLIC HEALTH SERVICE ACT. 

23 Title III of the Public Health Service Act (42 U.S.C. 

24 241 et seq.) is amended by adding at the end the following 

25 part: 
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1 ‘‘PART R—PREVENTION OF ELDER FALLS 

2 ‘‘SEC. 399AA. PUBLIC AND PROFESSIONAL EDUCATION. 

3 ‘‘(a) IN GENERAL.—Subject to the availability of ap4 propriations, the Secretary shall—

5 ‘‘(1) oversee and support a three-year national 

6 education campaign to be carried out by the Na7 tional Safety Council to be directed principally to el8 ders, their families, and health care providers and 

9 focusing on ways of reducing the risk of elder falls 

10 and preventing repeat falls; 

11 ‘‘(2) provide grants to qualified organizations 

12 and institutions for the purpose of organizing State13 level coalitions of appropriate State and local agen14 cies, safety, health, senior citizen and other organi15 zations to design and carry out local education cam16 paigns, focusing on ways of reducing the risk of 

17 elder falls and preventing repeat falls; and 

18 ‘‘(3) provide grants and contracts to qualified 

19 organizations and institutions for the purpose of 

20 providing state-of-the-art continued education to 

21 health and allied health professionals to effect geri22 atric fall prevention. 

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

24 term ‘allied health professionals’ has the meaning given 

25 such term in section 799B. 
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1 ‘‘SEC. 399AA–1. RESEARCH. 

2 ‘‘(a) IN GENERAL.—Subject to the availability of ap3 propriations, the Secretary shall—

4 ‘‘(1) conduct and support research to—

5 ‘‘(A) improve the identification of elders 

6 with a high risk of falls; 

7 ‘‘(B) improve data collection and analysis 

8 to identify fall risk and protective factors; 

9 ‘‘(C) improve strategies that are proven to 

10 be effective in reducing subsequent falls by el11 derly fall victims; 

12 ‘‘(D) expand proven interventions to pre13 vent elder falls; 

14 ‘‘(E) improve the diagnosis, treatment, and 

15 rehabilitation of elderly fall victims; and 

16 ‘‘(F) assess the risk of falls occurring in 

17 various settings. 

18 ‘‘(2) conduct and support research concerning 

19 barriers to the adoption of proven interventions with 

20 respect to the prevention of elder falls (such as 

21 medication review and vision enhancement); and 

22 ‘‘(3) evaluate the effectiveness of community 

23 programs to prevent assisted living and nursing 

24 home falls by elders. 

25 ‘‘(b) ADMINISTRATION.—In carrying out subsection 

26 (a), the Secretary shall—
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1 ‘‘(1) conduct research and surveillance activities 

2 related to the community-based and populations3 based aspects of elder falls prevention through the 

4 Director of the Centers for Disease Control and Pre5 vention; 

6 ‘‘(2) conduct research related to elder fall pre7 vention in health care delivery settings and clinical 

8 treatment and rehabilitation of elderly fall victims 

9 through the Director of the Agency for Healthcare 

10 Research and Quality; and 

11 ‘‘(3) ensure the coordination of the activities 

12 described in paragraphs (1) and (2). 

13 ‘‘(c) GRANTS.—The Secretary shall award grants and 

14 contracts to qualified organizations and institutions to en15 able such organizations and institutions to provide profes16 sional education for physicians and allied health profes17 sionals in elder fall prevention. In awarding these grants 

18 and contracts, the Secretary shall give appropriate priority 

19 to projects that show proven capacity to be self supporting 

20 within two years after the onset of the project. 

21 ‘‘SEC. 399AA–2. DEMONSTRATION PROJECTS. 

22 ‘‘(a) IN GENERAL.—Subject to the availability of ap23 propriations, the Secretary, acting through the Director 

24 of the Centers for Disease Control and Prevention and in 

25 consultation with the Director of the Agency for 
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1 Healthcare Research and Quality, shall carry out the fol2 lowing: 

3 ‘‘(1) Oversee and support demonstration and 

4 research projects to be carried out by the National 

5 Safety Council in the following areas: 

6 ‘‘(A) A multi-State demonstration project 

7 assessing the utility of targeted elder-falls risk 

8 screening and referral programs. 

9 ‘‘(B) Programs targeting newly-discharged 

10 fall victims who are at a high risk for second 

11 falls, which shall include, but not be limited to 

12 modification projects for elders with multiple 

13 sensory impairments, video and web-enhanced 

14 fall prevention programs for caregivers in multi15 family housing settings, and development of 

16 technology to prevent and detect falls. 

17 ‘‘(C) Private sector and public-private 

18 partnerships, involving home remodeling, home 

19 design and remodeling (in accordance with ac20 cepted building codes and standards) and nurs21 ing home and hospital patient supervision. 

22 ‘‘(D) Private sector and public-private 

23 partnerships to develop technology to prevent 

24 falls and prevent or reduce injuries if falls 

25 occur. 
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1 ‘‘(E) Hospital-based geriatric fall preven2 tion and treatment centers. 

3 ‘‘(F) Medicaid sponsored community 

4 projects for comprehensive geriatric fall preven5 tion of the type recently adopted by the States 

6 of Pennsylvania, New York, and Florida where7 by Medicaid elders are comprehensively 

8 screened, counseled, referred, case managed, 

9 and otherwise so treated as to reduce hospital 

10 admissions for fall related injuries by 60 per11 cent or more. 

12 ‘‘(G) Provide grants to not less than four 

13 States and to four hospitals to expand the pro14 grams identified in subparagraphs (E) and (F). 

15 In selecting State grantees under this subpara16 graph, the Secretary shall give appropriate pri17 ority to States that have adopted legislation 

18 that either—

19 ‘‘(i) adopts Medicaid-sponsored com20 prehensive fall prevention projects; or 

21 ‘‘(ii) requires allied health professional 

22 licensing boards to provide at least 1 hour 

23 of continuing education per year on geri24 atric fall prevention. 
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1 In all demonstration projects under this paragraph, 

2 the Secretary shall give appropriate priority to 

3 projects that show proven capacity to be self sup4 porting within 2 years of the onset of the project. 

5 ‘‘(2)(A) Provide grants and contracts to quali6 fied organizations and institutions to design and 

7 carry out elder falls prevention programs in residen8 tial and institutional settings. 

9 ‘‘(B) Provide one or more grants to one or 

10 more qualified applicants in order to carry out a 

11 multi-State demonstration project to implement 

12 elder falls prevention programs targeted toward 

13 multi-family residential settings with high concentra14 tions of elders, including identifying high risk popu15 lations, evaluating residential facilities, conducting 

16 screening to identify high risk individuals, providing 

17 pre-fall counseling, coordinating services with health 

18 care and social service providers and coordinating 

19 post-fall counseling, treatment, and rehabilitation. 

20 ‘‘(C) Provide one or more grants to qualified 

21 applicants to conduct evaluations of the effectiveness 

22 of the demonstration projects in this section. 

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

24 term ‘Medicaid’ means the program under title XIX of the 

25 Social Security Act. 
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1 ‘‘SEC. 399AA–3. AUTHORIZATION OF APPROPRIATIONS. 

2 ‘‘(a) IN GENERAL.—In order to carry out the provi3 sions of this part, there are authorized to be appro4 priated—

5 ‘‘(1) to carry out the national public education 

6 provisions described in section 399AA(1), 

7 $5,000,000 for each of fiscal years 2004 through 

8 2006; 

9 ‘‘(2) to carry out the State public education 

10 campaign provisions of section 399AA(2), 

11 $4,000,000 for each of fiscal years 2004 through 

12 2006; 

13 ‘‘(3) to carry out the professional and edu14 cational campaign provision of section 399AA(3), 

15 $5,000,000 for each of fiscal years 2004 through 

16 2006; 

17 ‘‘(4) to carry out research projects described in 

18 section 399AA–1, $5,000,000 for each of fiscal years 

19 2004 through 2006; 

20 ‘‘(5) to carry out the demonstration projects de21 scribed in section 399AA–2(1), $11,000,000 for 

22 each of fiscal years 2004 through 2006; and 

23 ‘‘(6) to carry out the demonstration and re24 search projects described in section 399AA–2(2), 

25 $8,000,000 for each of fiscal years 2004 through 

26 2006. 
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1 ‘‘(b) ALLOCATION.—In the case of each program for 

2 which an authorization of appropriations is established in 

3 subsection (a) and under which program the Secretary is 

4 authorized to make awards of grants or contracts to pri5 vate entities, the Secretary shall reserve from the amount 

6 appropriated under such subsection for the program not 

7 less than 30 percent for making such awards.’’. 

8 SEC. 5. REVIEW OF REIMBURSEMENT POLICIES. 

9 (a) IN GENERAL.—The Secretary of Health and 

10 Human Services shall undertake a review of the effects 

11 of elder falls on the costs of the programs under titles 

12 XVIII and XIX of the Social Security Act (referred to in 

13 this section as the ‘‘Medicare’’ and ‘‘Medicaid’’ programs, 

14 respectively) programs and the potential for reducing costs 

15 by expanding services covered by these two programs. This 

16 review shall include a review of the reimbursement policies 

17 of Medicare and Medicaid in order to determine if addi18 tional fall-related education, prevention, and early preven19 tion services should be covered or reimbursement guide20 lines should be modified. 

21 (b) REPORT.—Not later than 18 months after the 

22 date of the enactment of this Act, the Secretary of Health 

23 and Human Services shall submit to the Congress a report 
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1 describing the findings of the Secretary in conducting the 

2 review under subsection (a).

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