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Union Calendar No. 260

108TH CONGRESS 

2D SESSION H. R. 3658

[Report No. 108–453] 

To amend the Public Health Service Act to strengthen education, prevention, 

and treatment programs relating to stroke, and for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

DECEMBER 8, 2003

Mrs. CAPPS (for herself, Mr. PICKERING, Mr. DINGELL, Mr. BARTON of 

Texas, Mr. BROWN of Ohio, Mr. DEAL of Georgia, Mr. WAXMAN, Mr. 

SHIMKUS, Mr. PALLONE, Mr. GORDON, Mr. ENGEL, Mr. WYNN, Mr. 

GREEN of Texas, Mr. DOYLE, Mr. ALLEN, Ms. SCHAKOWSKY, and Ms. 

SOLIS) introduced the following bill; which was referred to the Committee 

on Energy and Commerce 

MARCH 30, 2004

Additional sponsors: Mr. NORWOOD, Mr. DAVIS OF FLORIDA, Mr. YOUNG of 

Florida, Mr. TOWNS, Mr. ISAKSON, Mr. DAVIS of Illinois, Ms. ESHOO, 

Mr. LEACH, Mr. STARK, Mr. JOHN, Mr. KENNEDY of Rhode Island, Mr. 

FORD, Mr. MCNULTY, Mr. GRIJALVA, Mr. ACEVEDO-VILA ́, Ms. KAPTUR, 

Mr. LANTOS, Mr. UDALL of New Mexico, Mr. SNYDER, Mr. KIND, Mr. 

CUMMINGS, Mr. HALL, Mr. WALSH, Mr. TANNER, Mr. WEXLER, Mr. 

TURNER of Texas, Mr. LUCAS of Kentucky, Mr. SMITH of New Jersey, 

Mr. FROST, Mr. TERRY, Mr. LYNCH, Mr. STRICKLAND, Mr. PRICE of 

North Carolina, Mr. MOORE, Mr. SANDLIN, Mr. SCHIFF, Ms. BALDWIN, 

Mr. BURR, Mr. FOSSELLA, Mr. STENHOLM, Mr. LAHOOD, Mr. VAN

HOLLEN, Mr. RAMSTAD, Mr. NETHERCUTT, Mrs. CHRISTENSEN, Mr. 

QUINN, Mr. FRANK of Massachusetts, Mr. ROTHMAN, Mr. JACKSON of 

Illinois, Mr. BALLANCE, Mr. MATHESON, Ms. MCCOLLUM, Mr. 

HULSHOF, Mr. MEEHAN, Mr. HOLDEN, Mr. WU, Mr. TAYLOR of Mississippi, Mr. HINCHEY, Mr. GEORGE MILLER of California, Mr. LINDER, 

Mr. KILDEE, Mr. SERRANO, Mrs. NAPOLITANO, Mr. LANGEVIN, Mr. 

WALDEN of Oregon, Ms. WOOLSEY, Mr. EMANUEL, Mr. BOSWELL, Mr. 

ISSA, Mr. KING of New York, Mr. HOEFFEL, Mr. MCDERMOTT, Mr. 

BISHOP of Georgia, Mr. BURNS, Mr. SANDERS, Mr. PUTNAM, Mr. INSLEE, Mr. OWENS, Mr. JENKINS, Mr. ROSS, Mr. NADLER, Mr. DOGGETT, 
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Mr. CLAY, Mr. ROGERS of Michigan, Mr. LOBIONDO, Ms. DELAURO, Mr. 

LEVIN, Ms. MCCARTHY of Missouri, Mr. GONZALEZ, Mr. LARSON of Connecticut, Mr. FOLEY, Mr. PAYNE, Mr. HINOJOSA, Mr. HONDA, Mrs. 

TAUSCHER, Mr. FILNER, Mr. SKELTON, Mr. CRAMER, Mr. VISCLOSKY, 

Ms. BERKLEY, Mr. RODRIGUEZ, Mr. SESSIONS, Mr. PETERSON of Minnesota, Mr. BOEHLERT, Mr. SPRATT, Mrs. KELLY, Mr. LINCOLN DIAZBALART of Florida, Mrs. DAVIS of California, and Mr. DAVIS of Tennessee 

MARCH 30, 2004 

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 December 8, 2003] 

A BILL

To amend the Public Health Service Act to strengthen education, prevention, and treatment programs relating to 

stroke, 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 ‘‘Stroke Treatment and 

5 Ongoing Prevention Act’’. 

6 SEC. 2. AMENDMENTS TO PUBLIC HEALTH SERVICE ACT RE7 GARDING STROKE PROGRAMS. 

8 (a) STROKE EDUCATION AND INFORMATION PRO9 GRAMS.—Title III of the Public Health Service Act (42 

10 U.S.C. 241 et seq.) is amended by adding at the end the 

11 following: 
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1 ‘‘PART R—STROKE EDUCATION, INFORMATION, 

2 AND DATA COLLECTION PROGRAMS 

3 ‘‘SEC. 399AA. STROKE PREVENTION AND EDUCATION CAM4 PAIGN. 

5 ‘‘(a) IN GENERAL.—The Secretary shall carry out an 

6 education and information campaign to promote stroke pre7 vention and increase the number of stroke patients who seek 

8 immediate treatment. 

9 ‘‘(b) AUTHORIZED ACTIVITIES.—In implementing the 

10 education and information campaign under subsection (a), 

11 the Secretary may—

12 ‘‘(1) make public service announcements about 

13 the warning signs of stroke and the importance of 

14 treating stroke as a medical emergency; 

15 ‘‘(2) provide education regarding ways to pre16 vent stroke and the effectiveness of stroke treatment; 

17 and 

18 ‘‘(3) carry out other activities that the Secretary 

19 determines will promote prevention practices among 

20 the general public and increase the number of stroke 

21 patients who seek immediate care. 

22 ‘‘(c) MEASUREMENTS.—In implementing the edu23 cation and information campaign under subsection (a), the 

24 Secretary shall—

25 ‘‘(1) measure public awareness before the start of 

26 the campaign to provide baseline data that will be 
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1 used to evaluate the effectiveness of the public aware2 ness efforts; 

3 ‘‘(2) establish quantitative benchmarks to meas4 ure the impact of the campaign over time; and 

5 ‘‘(3) measure the impact of the campaign not less 

6 than once every 2 years or, if determined appropriate 

7 by the Secretary, at shorter intervals. 

8 ‘‘(d) NO DUPLICATION OF EFFORT.—In carrying out 

9 this section, the Secretary shall avoid duplicating existing 

10 stroke education efforts by other Federal Government agen11 cies. 

12 ‘‘(e) CONSULTATION.—In carrying out this section, the 

13 Secretary may consult with organizations and individuals 

14 with expertise in stroke prevention, diagnosis, treatment, 

15 and rehabilitation. 

16 ‘‘SEC. 399BB. PAUL COVERDELL NATIONAL ACUTE STROKE 

17 REGISTRY AND CLEARINGHOUSE. 

18 ‘‘The Secretary, acting through the Centers for Disease 

19 Control and Prevention, shall maintain the Paul Coverdell 

20 National Acute Stroke Registry and Clearinghouse by—

21 ‘‘(1) continuing to develop and collect specific 

22 data points and appropriate benchmarks for ana23 lyzing care of acute stroke patients; 

24 ‘‘(2) collecting, compiling, and disseminating in25 formation on the achievements of, and problems expe-
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1 rienced by, State and local agencies and private enti2 ties in developing and implementing emergency med3 ical systems and hospital-based quality of care inter4 ventions; and 

5 ‘‘(3) carrying out any other activities the Sec6 retary determines to be useful to maintain the Paul 

7 Coverdell National Acute Stroke Registry and Clear8 inghouse to reflect the latest advances in all forms of 

9 stroke care. 

10 ‘‘SEC. 399CC. STROKE DEFINITION. 

11 ‘‘For purposes of this part, the term ‘stroke’ means a 

12 ‘brain attack’ in which blood flow to the brain is inter13 rupted or in which a blood vessel or aneurysm in the brain 

14 breaks or ruptures. 

15 ‘‘SEC. 399DD. AUTHORIZATION OF APPROPRIATIONS. 

16 ‘‘There is authorized to be appropriated to carry out 

17 this part $5,000,000 for each of fiscal years 2005 through 

18 2009.’’. 

19 (b) EMERGENCY MEDICAL PROFESSIONAL DEVELOP20 MENT.—Section 1251 of the Public Health Service Act (42 

21 U.S.C. 300d–51) is amended to read as follows: 
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1 ‘‘SEC. 1251. MEDICAL PROFESSIONAL DEVELOPMENT IN AD2 VANCED STROKE AND TRAUMATIC INJURY 

3 TREATMENT AND PREVENTION. 

4 ‘‘(a) RESIDENCY AND OTHER PROFESSIONAL TRAIN5 ING.—The Secretary may make grants to public and non6 profit entities for the purpose of planning, developing, and 

7 enhancing approved residency training programs and other 

8 professional training for appropriate health professions in 

9 emergency medicine, including emergency medical services 

10 professionals, to improve stroke and traumatic injury pre11 vention, diagnosis, treatment, and rehabilitation. 

12 ‘‘(b) CONTINUING EDUCATION ON STROKE AND TRAU13 MATIC INJURY.—

14 ‘‘(1) GRANTS.—The Secretary, acting through 

15 the Administrator of the Health Resources and Serv16 ices Administration, may make grants to qualified 

17 entities for the development and implementation of 

18 education programs for appropriate health care pro19 fessionals in the use of newly developed diagnostic ap20 proaches, technologies, and therapies for health profes21 sionals involved in the prevention, diagnosis, treat22 ment, and rehabilitation of stroke or traumatic in23 jury. 

24 ‘‘(2) DISTRIBUTION OF GRANTS.—In awarding 

25 grants under this subsection, the Secretary shall give 

26 preference to qualified entities that will train health 
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1 care professionals that serve areas with a significant 

2 incidence of stroke or traumatic injuries. 

3 ‘‘(3) APPLICATION.—A qualified entity desiring 

4 a grant under this subsection shall submit to the Sec5 retary an application at such time, in such manner, 

6 and containing such information as the Secretary 

7 may require, including a plan for the rigorous eval8 uation of activities carried out with amounts received 

9 under the grant. 

10 ‘‘(4) DEFINITIONS.—For purposes of this sub11 section: 

12 ‘‘(A) The term ‘qualified entity’ means a 

13 consortium of public and private entities, such 

14 as universities, academic medical centers, hos15 pitals, and emergency medical systems that are 

16 coordinating education activities among pro17 viders serving in a variety of medical settings.

18 ‘‘(B) The term ‘stroke’ means a ‘brain at19 tack’ in which blood flow to the brain is inter20 rupted or in which a blood vessel or aneurysm 

21 in the brain breaks or ruptures. 

22 ‘‘(c) REPORT.—Not later than 1 year after the alloca23 tion of grants under this section, the Secretary shall submit 

24 to the Committee on Health, Education, Labor, and Pen25 sions of the Senate and the Committee on Energy and Com-
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1 merce of the House of Representatives a report on the results 

2 of activities carried out with amounts received under this 

3 section. 

4 ‘‘(d) AUTHORIZATION OF APPROPRIATIONS.—There is 

5 authorized to be appropriated to carry out this section 

6 $4,000,000 for each of fiscal years 2005 through 2009. The 

7 Secretary shall equitably allocate the funds authorized to 

8 be appropriated under this section between efforts to address 

9 stroke and efforts to address traumatic injury.’’. 

10 SEC. 3. PILOT PROJECT ON TELEHEALTH STROKE TREAT11 MENT. 

12 (a) ESTABLISHMENT.—Part D of title III of the Public 

13 Health Service Act (42 U.S.C. 254b et seq.) is amended by 

14 inserting after section 330L the following: 

15 ‘‘SEC. 330M. TELEHEALTH STROKE TREATMENT GRANT 

16 PROGRAM. 

17 ‘‘(a) GRANTS.—The Secretary may make grants to 

18 States, and to consortia of public and private entities lo19 cated in any State that is not a grantee under this section, 

20 to conduct a 5-year pilot project over the period of fiscal 

21 years 2005 through 2009 to improve stroke patient outcomes 

22 by coordinating health care delivery through telehealth net23 works. 
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1 ‘‘(b) ADMINISTRATION.—The Secretary shall admin2 ister this section through the Director of the Office for the 

3 Advancement of Telehealth. 

4 ‘‘(c) CONSULTATION.—In carrying out this section, for 

5 the purpose of better coordinating program activities, the 

6 Secretary shall consult with—

7 ‘‘(1) officials responsible for other Federal pro8 grams involving stroke research and care, including 

9 such programs established by the Stroke Treatment 

10 and Ongoing Prevention Act; and 

11 ‘‘(2) organizations and individuals with exper12 tise in stroke prevention, diagnosis, treatment, and 

13 rehabilitation. 

14 ‘‘(d) USE OF FUNDS.—

15 ‘‘(1) IN GENERAL.—The Secretary may not make 

16 a grant to a State or a consortium under this section 

17 unless the State or consortium agrees to use the grant 

18 for the purpose of—

19 ‘‘(A) identifying entities with expertise in 

20 the delivery of high-quality stroke prevention, di21 agnosis, treatment, and rehabilitation; 

22 ‘‘(B) working with those entities to establish 

23 or improve telehealth networks to provide stroke 

24 treatment assistance and resources to health care 
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1 professionals, hospitals, and other individuals 

2 and entities that serve stroke patients; 

3 ‘‘(C) informing emergency medical systems 

4 of the location of entities identified under sub5 paragraph (A) to facilitate the appropriate 

6 transport of individuals with stroke symptoms; 

7 ‘‘(D) establishing networks to coordinate 

8 collaborative activities for stroke prevention, di9 agnosis, treatment, and rehabilitation; 

10 ‘‘(E) improving access to high-quality stroke 

11 care, especially for populations with a shortage 

12 of stroke care specialists and populations with a 

13 high incidence of stroke; and 

14 ‘‘(F) conducting ongoing performance and 

15 quality evaluations to identify collaborative ac16 tivities that improve clinical outcomes for stroke 

17 patients.

18 ‘‘(2) ESTABLISHMENT OF CONSORTIUM.—The 

19 Secretary may not make a grant to a State under 

20 this section unless the State agrees to establish a con21 sortium of public and private entities, including uni22 versities and academic medical centers, to carry out 

23 the activities described in paragraph (1). 

24 ‘‘(3) PROHIBITION.—The Secretary may not 

25 make a grant under this section to a State that has 
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1 an existing telehealth network that is or may be used 

2 for improving stroke prevention, diagnosis, treatment, 

3 and rehabilitation, or to a consortium located in such 

4 a State, unless the State or consortium agrees that—

5 ‘‘(A) the State or consortium will use an ex6 isting telehealth network to achieve the purpose 

7 of the grant; and 

8 ‘‘(B) the State or consortium will not estab9 lish a separate network for such purpose. 

10 ‘‘(e) PRIORITY.—In selecting grant recipients under 

11 this section, the Secretary shall give priority to any appli12 cant that submits a plan demonstrating how the applicant, 

13 and where applicable the members of the consortium de14 scribed in subsection (d)(2), will use the grant to improve 

15 access to high-quality stroke care for populations with 

16 shortages of stroke-care specialists and populations with a 

17 high incidence of stroke. 

18 ‘‘(f) GRANT PERIOD.—The Secretary may not award 

19 a grant to a State or a consortium under this section for 

20 any period that—

21 ‘‘(1) is greater than 3 years; or 

22 ‘‘(2) extends beyond the end of fiscal year 2009. 

23 ‘‘(g) RESTRICTION ON NUMBER OF GRANTS.—In car24 rying out the 5-year pilot project under this section, the 

25 Secretary may not award more than 7 grants. 
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1 ‘‘(h) APPLICATION.—To seek a grant under this sec2 tion, a State or a consortium of public and private entities 

3 shall submit an application to the Secretary in such form, 

4 in such manner, and containing such information as the 

5 Secretary may require. At a minimum, the Secretary shall 

6 require each such application to outline how the State or 

7 consortium will establish baseline measures and benchmarks 

8 to evaluate program outcomes. 

9 ‘‘(i) DEFINITION.—In this section, the term ‘stroke’ 

10 means a ‘brain attack’ in which blood flow to the brain 

11 is interrupted or in which a blood vessel or aneurysm in 

12 the brain breaks or ruptures. 

13 ‘‘(j) AUTHORIZATION OF APPROPRIATIONS.—There are 

14 authorized to be appropriated to carry out this section 

15 $10,000,000 for fiscal year 2005, $13,000,000 for fiscal year 

16 2006, $15,000,000 for fiscal year 2007, $8,000,000 for fiscal 

17 year 2008, and $4,000,000 for fiscal year 2009.’’. 

18 (b) STUDY; REPORTS.—

19 (1) FINAL REPORT.—Not later than March 31, 

20 2010, the Secretary of Health and Human Services 

21 shall conduct a study of the results of the telehealth 

22 stroke treatment grant program under section 330M 

23 of the Public Health Service Act (added by subsection 

24 (a)) and submit to the Congress a report on such re25 sults that includes the following: 
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1 (A) An evaluation of the grant program 

2 outcomes, including quantitative analysis of 

3 baseline and benchmark measures. 

4 (B) Recommendations on how to promote 

5 stroke networks in ways that improve access to 

6 clinical care in rural and urban areas and re7 duce the incidence of stroke and the debilitating 

8 and costly complications resulting from stroke. 

9 (C) Recommendations on whether similar 

10 telehealth grant programs could be used to im11 prove patient outcomes in other public health 

12 areas. 

13 (2) INTERIM REPORTS.—The Secretary of Health 

14 and Human Services may provide interim reports to 

15 the Congress on the telehealth stroke treatment grant 

16 program under section 330M of the Public Health 

17 Service Act (added by subsection (a)) at such inter18 vals as the Secretary determines to be appropriate. 

19 SEC. 4. RULE OF CONSTRUCTION. 

20 Nothing in this Act shall be construed to authorize the 

21 Secretary of Health and Human Services to establish Fed22 eral standards for the treatment of patients or the licensure 

23 of health care professionals.
Union Calendar No. 260

108TH CONGRESS 

2D SESSION H. R. 3658

[Report No. 108–453] 

A BILL

To amend the Public Health Service Act to 

poses. programs relating to stroke, and for other purstrengthen education, prevention, and treatment 

MARCH 30, 2004

Reported with an amendment, committed to the Comand ordered to be printed mittee of the Whole House on the State of the Union,