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[Congressional Bills 110th Congress]
[From the U.S. Government Publishing Office]
[S. 999 Reported in Senate (RS)]

                                                       Calendar No. 699
110th CONGRESS
  2d Session
                                 S. 999

 To amend the Public Health Service Act to improve stroke prevention, 
               diagnosis, treatment, and rehabilitation.

_______________________________________________________________________

                   IN THE SENATE OF THE UNITED STATES

                             March 27, 2007

  Mr. Cochran (for himself, Mr. Kennedy, Mr. Warner, Mr. Dorgan, Mrs. 
Murray, Ms. Collins, Mr. Reed, Ms. Cantwell, Mr. Coleman, Mr. Burr, Mr. 
    Akaka, Mr. Chambliss, Mr. Isakson, Mr. Menendez, Mrs. Dole, Mr. 
     Sanders, Mr. Carper, Mr. Cardin, Mr. Brown, Mr. Johnson, Mr. 
 Lautenberg, Mr. Domenici, Mr. Kerry, Mrs. Boxer, Mr. Lott, Mr. Hatch, 
Ms. Murkowski, Mr. Conrad, Mr. Lieberman, Mr. Vitter, Mr. Bingaman, Mr. 
  Whitehouse, Mr. Bunning, Mr. Casey, Mr. Dodd, Mr. Sessions, and Ms. 
  Klobuchar) introduced the following bill; which was read twice and 
  referred to the Committee on Health, Education, Labor, and Pensions

                             April 16, 2008

               Reported by Mr. Kennedy, with an amendment
 [Strike out all after the enacting clause and insert the part printed 
                               in italic]

_______________________________________________________________________

                                 A BILL

 
 To amend the Public Health Service Act to improve stroke prevention, 
               diagnosis, treatment, and rehabilitation.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

<DELETED>SECTION 1. SHORT TITLE.</DELETED>

<DELETED>    This Act may be cited as the ``Stroke Treatment and 
Ongoing Prevention Act of 2007''.</DELETED>

<DELETED>SEC. 2. FINDINGS AND GOAL.</DELETED>

<DELETED>    (a) Findings.--The Congress finds as follows:</DELETED>
        <DELETED>    (1) Stroke is the third leading cause of death in 
        the United States. Each year approximately 700,000 Americans 
        suffer a new or recurrent stroke and over 160,000 Americans die 
        from stroke.</DELETED>
        <DELETED>    (2) Stroke costs the United States $35,000,000,000 
        in direct costs and $56,800,000,000 in indirect costs each 
        year.</DELETED>
        <DELETED>    (3) Stroke is one of the leading causes of adult 
        disability in the United States. Between 15 percent and 30 
        percent of stroke survivors are permanently disabled. 
        Presently, there are 4,700,000 stroke survivors living in the 
        United States.</DELETED>
        <DELETED>    (4) Members of the general public have difficulty 
        recognizing the symptoms of stroke and are unaware that stroke 
        is a medical emergency. Frequently, stroke patients wait as 
        many as 22 hours or more before presenting at the emergency 
        room. Forty-two percent of individuals over the age of 50 do 
        not recognize numbness or paralysis in the face, arm, or leg as 
        a sign of stroke and 17 percent of them cannot name a single 
        stroke symptom.</DELETED>
        <DELETED>    (5) Recent advances in stroke treatment can 
        significantly improve the outcome for stroke patients, but 
        these therapies must be administered properly and promptly. 
        Only 3 percent of stroke patients who are candidates for acute 
        stroke intravenous thrombolytic drug therapy receive the 
        appropriate medication.</DELETED>
        <DELETED>    (6) New technologies, therapies, and diagnostic 
        approaches are currently being developed that will extend the 
        therapeutic timeframe and result in greater treatment efficacy 
        for stroke patients.</DELETED>
        <DELETED>    (7) Few States and communities have developed and 
        implemented stroke awareness programs, prevention programs, or 
        comprehensive stroke care systems.</DELETED>
        <DELETED>    (8) The degree of disability resulting from stroke 
        can be reduced substantially by educating the general public 
        about stroke and by improving the systems for the provision of 
        stroke care in the United States.</DELETED>
<DELETED>    (b) Goal.--It is the goal of this Act to improve the 
provision of stroke care in every State and territory and in the 
District of Columbia, and to increase public awareness about the 
prevention, detection, and treatment of stroke.</DELETED>

<DELETED>SEC. 3. AMENDMENT REGARDING STROKE PREVENTION, TREATMENT, AND 
              REHABILITATION.</DELETED>

<DELETED>    Title III of the Public Health Service Act (42 U.S.C. 241 
et seq.) is amended by adding at the end the following:</DELETED>

  <DELETED>``PART S--STROKE PREVENTION, TREATMENT, AND REHABILITATION 
                           PROGRAMS</DELETED>

<DELETED>``Subpart I--Authorities and Duties of the Secretary</DELETED>

<DELETED>``SEC. 399HH. RESPONSIBILITIES OF THE SECRETARY.</DELETED>

<DELETED>    ``(a) In General.--The Secretary shall, with respect to 
stroke care--</DELETED>
        <DELETED>    ``(1) establish and evaluate a grant program under 
        section 399JJ to enable States to develop statewide stroke care 
        systems;</DELETED>
        <DELETED>    ``(2) foster the development of appropriate, 
        modern systems of stroke care through the sharing of 
        information among agencies and individuals involved in the 
        study and provision of such care;</DELETED>
        <DELETED>    ``(3) provide to State and local agencies 
        technical assistance;</DELETED>
        <DELETED>    ``(4) develop a model curriculum for training 
        emergency medical services personnel, including dispatchers, 
        first responders, emergency medical technicians, and 
        paramedics, in the identification, assessment, stabilization, 
        and prehospital treatment of stroke patients;</DELETED>
        <DELETED>    ``(5) issue recommendations or guidelines on best 
        practices for the establishment and operation of statewide 
        stroke systems, including recommendations or guidelines on best 
        practices for the establishment and operation of stroke care 
        centers; and</DELETED>
        <DELETED>    ``(6) provide, to the extent practicable, 
        information to the public on the recognition of the signs and 
        symptoms of stroke and the appropriate actions to take to 
        assist an individual in obtaining appropriate and timely care 
        following a stroke.</DELETED>
<DELETED>    ``(b) Grants, Cooperative Agreements, and Contracts.--The 
Secretary may make grants, and enter into cooperative agreements and 
contracts, for the purpose of carrying out subsection (a).</DELETED>
<DELETED>    ``(c) Rules of Construction.--</DELETED>
        <DELETED>    ``(1) Existing guidelines.--Nothing in subsection 
        (a)(5) shall be construed to require the Secretary to issue new 
        recommendations or guidelines where existing recommendations or 
        guidelines issued or adopted by the Secretary are applicable to 
        the establishment of statewide stroke systems. Where an 
        existing recommendation or guideline is applicable to the 
        establishment of statewide stroke systems, the Secretary may 
        deem such recommendation or guideline to have been issued under 
        subsection (a)(5).</DELETED>
        <DELETED>    ``(2) Advisory nature of guidelines.--
        Recommendations or guidelines issued under subsection (a)(5) 
        shall be considered advisory in nature and shall not be 
        construed to constitute a standard of care for the treatment of 
        stroke.</DELETED>

<DELETED>``SEC. 399II. PAUL COVERDELL NATIONAL ACUTE STROKE 
              REGISTRY.</DELETED>

<DELETED>    ``The Secretary shall maintain the Paul Coverdell National 
Acute Stroke Registry by--</DELETED>
        <DELETED>    ``(1) continuing to develop and collect specific 
        data points as well as appropriate benchmarks for analyzing 
        care of acute stroke patients;</DELETED>
        <DELETED>    ``(2) continuing to develop a national registry 
        model that measures the delivery of care to patients with acute 
        stroke in order to provide real-time data and analysis to 
        reduce death and disability from stroke and improve the quality 
        of life for acute stroke survivors;</DELETED>
        <DELETED>    ``(3) fostering the development of effective, 
        modern stroke care systems (including the development of 
        policies related to emergency services systems) through the 
        sharing of information among agencies and individuals involved 
        in planning, furnishing, and studying such systems;</DELETED>
        <DELETED>    ``(4) collecting, compiling, and disseminating 
        information on the achievements of, and problems experienced 
        by, State and local agencies and private entities in developing 
        and implementing stroke care systems and, in carrying out this 
        paragraph, giving special consideration to the unique needs of 
        rural facilities and those facilities with inadequate resources 
        for providing high-quality prevention, acute treatment, post-
        acute treatment, and rehabilitation services for stroke 
        patients; and</DELETED>
        <DELETED>    ``(5) carrying out any other activities the 
        Secretary determines to be useful to fulfill the purposes of 
        the Paul Coverdell National Acute Stroke Registry.</DELETED>

       <DELETED>``Subpart II--State Stroke Care Systems</DELETED>

<DELETED>``SEC. 399JJ. GRANTS TO STATES FOR STROKE CARE 
              SYSTEMS.</DELETED>

<DELETED>    ``(a) Grants.--The Secretary shall award grants to States 
for the development and implementation of stroke care systems that 
provide high-quality prevention, diagnosis, treatment, and 
rehabilitation.</DELETED>
<DELETED>    ``(b) Required Uses.--</DELETED>
        <DELETED>    ``(1) In general.--In carrying out activities 
        described in subsection (a), each State that is awarded a grant 
        under this section shall--</DELETED>
                <DELETED>    ``(A) establish, enhance, or expand a 
                statewide stroke care system for the purpose of 
                ensuring access to high-quality stroke prevention, 
                diagnosis, treatment, and rehabilitation, except that 
                activities conducted under this subparagraph shall be 
                consistent with guidelines or recommendations issued by 
                the Secretary under section 399HH(a)(5) to the extent 
                that such guidelines or recommendations have been 
                issued;</DELETED>
                <DELETED>    ``(B) establish, enhance, or expand, as 
                appropriate, stroke care centers, except that 
                activities conducted under this subparagraph shall be 
                consistent with guidelines or recommendations issued by 
                the Secretary under section 399HH(a)(5), to the extent 
                that such guidelines or recommendations have been 
                issued;</DELETED>
                <DELETED>    ``(C) conduct evaluation activities to 
                monitor clinical outcomes and procedures and to verify 
                resources, infrastructure, and operations devoted to 
                stroke care;</DELETED>
                <DELETED>    ``(D) enhance, develop, and implement 
                model curricula for training emergency medical services 
                personnel in the identification, assessment, 
                stabilization, and prehospital treatment of stroke 
                patients which may, at the discretion of the State, 
                consist of or be based on the model curriculum 
                developed by the Secretary under section 
                399HH(a)(4);</DELETED>
                <DELETED>    ``(E) enhance coordination of emergency 
                medical services with respect to stroke care;</DELETED>
                <DELETED>    ``(F) establish, enhance, or improve a 
                central data reporting and analysis system described in 
                subsection (c);</DELETED>
                <DELETED>    ``(G) establish, enhance, or improve a 
                support network described in subsection (d) to provide 
                assistance to facilities with smaller populations of 
                stroke patients or less advanced on-site stroke 
                treatment resources;</DELETED>
                <DELETED>    ``(H) consult with organizations and 
                individuals with expertise in stroke prevention, 
                diagnosis, treatment, and rehabilitation; and</DELETED>
                <DELETED>    ``(I) with respect to carrying out 
                subparagraph (C) through (H), use the best available 
                evidence and consensus recommendations of professional 
                associations.</DELETED>
        <DELETED>    ``(2) Permissible uses.--In developing and 
        implementing a stroke care system described in paragraph (1), 
        each State that is awarded a grant under this section may--
        </DELETED>
                <DELETED>    ``(A) improve existing State stroke 
                prevention programs;</DELETED>
                <DELETED>    ``(B) conduct a stroke education and 
                information campaign, including by--</DELETED>
                        <DELETED>    ``(i) making public service 
                        announcements about the warning signs of stroke 
                        and the importance of treating stroke as a 
                        medical emergency; and</DELETED>
                        <DELETED>    ``(ii) providing education 
                        regarding ways to prevent stroke and the 
                        effectiveness of stroke treatment; 
                        and</DELETED>
                <DELETED>    ``(C) make grants to public and non-profit 
                private entities for medical professional development 
                in accordance with subsection (e).</DELETED>
<DELETED>    ``(c) Central Data Reporting and Analysis System.--A 
central data reporting and analysis system described in this subsection 
is a system that collects data from facilities that provide direct care 
to stroke patients and uses the data--</DELETED>
        <DELETED>    ``(1) to identify the number of stroke patients 
        treated in the State;</DELETED>
        <DELETED>    ``(2) to monitor patient care in the State for 
        stroke patients at all phases of stroke for the purpose of 
        evaluating the diagnosis, treatment, and treatment outcome of 
        such stroke patients;</DELETED>
        <DELETED>    ``(3) to identify the total amount of 
        uncompensated and under-compensated stroke care expenditures 
        for each fiscal year by each stroke care facility in the 
        State;</DELETED>
        <DELETED>    ``(4) to identify the number of acute stroke 
        patients who receive advanced drug therapy;</DELETED>
        <DELETED>    ``(5) to identify patients transferred within the 
        statewide stroke care system, including reasons for such 
        transfer; and</DELETED>
        <DELETED>    ``(6) to communicate to the greatest extent 
        practicable with the Paul Coverdell National Acute Stroke 
        Registry.</DELETED>
<DELETED>    ``(d) Support Network.--A support network described in 
this subsection may include the following:</DELETED>
        <DELETED>    ``(1) The use of telehealth technology to connect 
        facilities described in subsection (b)(1)(G) to more advanced 
        stroke care facilities.</DELETED>
        <DELETED>    ``(2) The provision of neuroimaging, laboratory, 
        and any other equipment necessary to facilitate the 
        establishment of a telehealth network.</DELETED>
        <DELETED>    ``(3) The use of phone consultation, where 
        useful.</DELETED>
        <DELETED>    ``(4) The use of referral links when a patient 
        needs more advanced care than is available at the facility 
        providing initial care.</DELETED>
        <DELETED>    ``(5) Any other assistance determined appropriate 
        by the State.</DELETED>
<DELETED>    ``(e) Medical Professional Development in Advanced Stroke 
Treatment and Prevention.--</DELETED>
        <DELETED>    ``(1) In general.--A State may use funds received 
        under a grant under this section to make subgrants to public 
        and non-profit private entities for the development and 
        implementation of education programs for appropriate medical 
        personnel and health professionals in the use of newly 
        developed diagnostic approaches, technologies, and therapies 
        for the prevention and treatment of stroke.</DELETED>
        <DELETED>    ``(2) Use of funds.--A public or non-profit 
        private entity shall use amounts received under a subgrant 
        under this subsection for the continuing education of 
        appropriate medical personnel in the use of newly developed 
        diagnostic approaches, technologies, and therapies for the 
        prevention and treatment of stroke.</DELETED>
        <DELETED>    ``(3) Distribution of subgrants.--In awarding 
        subgrants under this subsection, the Secretary shall ensure 
        that such subgrants are equitably distributed among the 
        geographical regions of the State and between urban and rural 
        populations.</DELETED>
        <DELETED>    ``(4) Application.--A public or non-profit private 
        entity desiring a subgrant under this subsection shall prepare 
        and submit to the State involved an application at such time, 
        in such manner, and containing such information as the State 
        may require, including a plan for the rigorous evaluation of 
        activities carried out with amounts received under such a 
        subgrant.</DELETED>
<DELETED>    ``(f) Restrictions on Use of Payments.--The Secretary may 
not, except as provided in paragraph (2), make payments to a State 
under this section for a fiscal year unless the State agrees that the 
payments will not be expended--</DELETED>
        <DELETED>    ``(1) to make cash payments to intended recipients 
        of services provided pursuant to this section;</DELETED>
        <DELETED>    ``(2) to satisfy any requirement for the 
        expenditure of non-Federal funds as a condition for the receipt 
        of Federal funds;</DELETED>
        <DELETED>    ``(3) to provide financial assistance to any 
        entity other than a public or nonprofit private entity; 
        or</DELETED>
        <DELETED>    ``(4) for construction, alteration, or improvement 
        of any building or facility.</DELETED>
<DELETED>    ``(g) Failure To Comply With Agreements.--</DELETED>
        <DELETED>    ``(1) Repayment of payments.--</DELETED>
                <DELETED>    ``(A) Requirement.--The Secretary may, in 
                accordance with paragraph (2), require a State to repay 
                any payments received by the State under this section 
                that the Secretary determines were not expended by the 
                State in accordance with the agreements required to be 
                made by the State as a condition of the receipt of 
                payments.</DELETED>
                <DELETED>    ``(B) Offset of amounts.--If a State fails 
                to make a repayment required in subparagraph (A), the 
                Secretary may offset the amount of the repayment 
                against any amount due to be paid to the State under 
                this section.</DELETED>
        <DELETED>    ``(2) Opportunity for a hearing.--Before requiring 
        repayment of payments under paragraph (1), the Secretary shall 
        provide to the State an opportunity for a hearing.</DELETED>
<DELETED>    ``(h) Application Requirements.--The Secretary may not 
award a grant to a State under this section unless--</DELETED>
        <DELETED>    ``(1) the State submits an application containing 
        agreements in accordance with this section;</DELETED>
        <DELETED>    ``(2) the agreements are made through 
        certification from the chief executive officer of the 
        State;</DELETED>
        <DELETED>    ``(3) with respect to such agreements, the 
        application provides assurances of compliance satisfactory to 
        the Secretary;</DELETED>
        <DELETED>    ``(4) the application contains the plan provisions 
        and the information required to be submitted to the Secretary; 
        and</DELETED>
        <DELETED>    ``(5) the application otherwise 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.</DELETED>
<DELETED>    ``(i) Technical Assistance.--The Secretary shall, without 
charge to a State receiving payments under this section, provide to the 
State (or to any public or nonprofit entity designated by the State) 
technical assistance with respect to the planning, development, and 
operation of any program carried out pursuant to this section. The 
Secretary may provide such technical assistance directly, through 
contract, or through grants.</DELETED>
<DELETED>    ``(j) Supplies and Services in Lieu of Grant Funds.--
</DELETED>
        <DELETED>    ``(1) In general.--Upon the request of a State 
        receiving payments under this section, the Secretary may, 
        subject to paragraph (2), provide supplies, equipment, and 
        services to the State and may detail to the State any officer 
        or employee of the Department of Health and Human Services, for 
        the purpose of assisting the State to achieve the purpose of 
        the payments.</DELETED>
        <DELETED>    ``(2) Reduction in payments.--With respect to a 
        request described in paragraph (1), the Secretary shall reduce 
        the amount of payments to the State under this section by an 
        amount equal to the costs of detailing personnel and the fair 
        market value of any supplies, equipment, or services provided 
        by the Secretary. The Secretary shall, for the payment of 
        expenses incurred in complying with such request, expend the 
        amounts withheld.</DELETED>
<DELETED>    ``(k) Report.--Not later than 3 years after the date of 
the enactment of the Stroke Treatment and Ongoing Prevention Act of 
2007, the Secretary shall report to the appropriate committees of the 
Congress on the activities of the States carried out pursuant to this 
section and section 399KK. Such report shall include an assessment of 
the extent to which Federal and State efforts to identify stroke 
centers, develop support networks, and enhance emergency medical 
services coordination and the training of emergency medical personnel, 
have increased the number of stroke patients who have received acute 
stroke consultation or therapy within the appropriate timeframe and 
reduced the level of disability due to stroke.</DELETED>
<DELETED>    ``(l) Limitation on Administrative Expenses.--The 
Secretary may not award a grant to a State under this section unless 
the State agrees to use not more than 10 percent of amounts received 
under the grant for administrative expenses.</DELETED>

<DELETED>``SEC. 399KK. PLANNING GRANTS.</DELETED>

<DELETED>    ``(a) Grants.--The Secretary may award a grant to a State 
to assist such State in formulating a plan to develop a stroke care 
system in accordance with section 399JJ or in otherwise meeting the 
requirements of such section.</DELETED>
<DELETED>    ``(b) Submission to Secretary.--The chief executive 
officer of a State that receives a grant under this section shall 
submit to the Secretary a copy of the plan developed using the amounts 
provided under such grant. Such plan shall be submitted to the 
Secretary as soon as practicable after the plan has been 
developed.</DELETED>
<DELETED>    ``(c) Single Grant Limitation.--A State is not eligible to 
receive a grant under this section if the State previously received a 
grant under this section.</DELETED>

<DELETED>``SEC. 399LL. SPECIAL CONSIDERATION.</DELETED>

<DELETED>    ``In awarding grants under this subpart, the Secretary 
shall give special consideration to any State that has submitted an 
application for carrying out programs under such a grant--</DELETED>
        <DELETED>    ``(1) in geographic areas in which there is--
        </DELETED>
                <DELETED>    ``(A) an elevated incidence or prevalence 
                of disability resulting from stroke; or</DELETED>
                <DELETED>    ``(B) an elevated incidence or prevalence 
                of stroke; or</DELETED>
        <DELETED>    ``(2) that demonstrates a significant need for 
        assistance in establishing a comprehensive stroke care 
        system.</DELETED>

          <DELETED>``Subpart III--General Provisions</DELETED>

<DELETED>``SEC. 399MM. GENERAL PROVISIONS.</DELETED>

<DELETED>    ``(a) Consultations.--In carrying out this part, the 
Secretary shall consult with organizations and individuals with 
expertise in stroke prevention, diagnosis, treatment, and 
rehabilitation.</DELETED>
<DELETED>    ``(b) Definitions.--In this part:</DELETED>
        <DELETED>    ``(1) State.--The term `State' means each of the 
        several States, the District of Columbia, the Commonwealth of 
        Puerto Rico, the Indian tribes, the Virgin Islands, Guam, 
        American Samoa, and the Commonwealth of the Northern Mariana 
        Islands.</DELETED>
        <DELETED>    ``(2) Stroke care system.--The term `stroke care 
        system' means a statewide system to provide for the diagnosis, 
        prehospital care, hospital definitive care, and rehabilitation 
        of stroke patients.</DELETED>
        <DELETED>    ``(3) Stroke.--The term `stroke' means a `brain 
        attack' in which blood flow to the brain is interrupted or in 
        which a blood vessel or aneurysm in the brain breaks or 
        ruptures.</DELETED>
<DELETED>    ``(c) Authorization of Appropriations.--There are 
authorized to be appropriated to carry out this part such sums as may 
be necessary for fiscal years 2008 through 2012.''.</DELETED>

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Stroke Treatment and Ongoing 
Prevention Act of 2008''.

SEC. 2. GOAL.

    It is the goal of this Act to improve the provision of stroke care 
in every State and territory and in the District of Columbia, and to 
increase public awareness about the prevention, detection, and 
treatment of stroke.

SEC. 3. AMENDMENT REGARDING STROKE PREVENTION, TREATMENT, AND 
              REHABILITATION.

    Title III of the Public Health Service Act (42 U.S.C. 241 et seq.) 
is amended by adding at the end the following:

  ``PART S--STROKE PREVENTION, TREATMENT, AND REHABILITATION PROGRAMS

          ``Subpart I--Authorities and Duties of the Secretary

``SEC. 399HH. RESPONSIBILITIES OF THE SECRETARY.

    ``(a) In General.--The Secretary may, with respect to stroke care--
            ``(1) establish and evaluate a grant program under section 
        399JJ to enable States or consortia of States to develop stroke 
        care systems;
            ``(2) foster the development of systems of stroke care 
        through total quality improvement of health systems providing 
        primary stroke prevention and identification, treatment, and 
        rehabilitation of individuals who experience a stroke;
            ``(3) provide to State, consortia of States, and local 
        agencies technical assistance; and
            ``(4) collaborate with appropriate medical and health 
        professional associations to disseminate evidenced-based 
        practices on stroke systems of care.
    ``(b) Grants, Cooperative Agreements, and Contracts.--The Secretary 
may make grants, and enter into cooperative agreements and contracts, 
for the purpose of carrying out subsection (a).

``SEC. 399II. SENSE OF THE SENATE CONCERNING THE PAUL COVERDELL 
              NATIONAL ACUTE STROKE REGISTRY.

    ``It is the sense of the Senate that, as evidenced by the Paul 
Coverdell National Acute Stroke Registry, the Secretary considers 
stroke systems of care when allocating discretionary funds relating to 
stroke.

     ``Subpart II--State or Consortia of States Stroke Care Systems

``SEC. 399JJ. GRANTS TO STATES OR CONSORTIA OF STATES FOR STROKE CARE 
              SYSTEMS.

    ``(a) Grants.--The Secretary may award grants to States or 
consortia of States for the development and implementation of stroke 
care systems that provide high-quality prevention, diagnosis, 
treatment, and rehabilitation.
    ``(b) Required Uses.--
            ``(1) In general.--In carrying out activities described in 
        subsection (a), each State or consortia of States that is 
        awarded a grant under this section shall--
                    ``(A) establish, enhance, or expand a statewide 
                stroke care system for the purpose of promoting the 
                total quality improvement of stroke care consistent 
                with evidence-based practices;
                    ``(B) establish, enhance, or expand, as 
                appropriate, stroke care centers, except that 
                activities conducted under this subparagraph shall be 
                consistent with evidence-based practices;
                    ``(C) conduct evaluation activities to monitor 
                clinical outcomes and procedures and mechanisms for 
                evaluating the effectiveness of the resources, 
                infrastructure, and operations devoted to stroke care;
                    ``(D) enhance, develop, and implement effective 
                methods for training emergency medical services 
                personnel in the identification, assessment, 
                stabilization, and prehospital treatment of stroke 
                patients;
                    ``(E) enhance coordination of emergency medical 
                services, ground transportation services, and air 
                transportation with respect to stroke care;
                    ``(F) establish, enhance, or improve a support 
                network described in subsection (c) to provide 
                assistance to facilities with smaller populations of 
                stroke patients or less advanced on-site stroke 
                treatment resources;
                    ``(G) consult with organizations and individuals 
                with expertise in stroke prevention, diagnosis, 
                treatment, and rehabilitation; and
                    ``(H) with respect to carrying out subparagraph (C) 
                through (H), use the best available evidence and 
                consensus recommendations of professional associations.
            ``(2) Permissible uses.--In developing and implementing a 
        stroke care system described in paragraph (1), each State or 
        consortia of States that is awarded a grant under this section 
        may--
                    ``(A) improve existing stroke prevention programs;
                    ``(B) conduct a stroke education and information 
                campaign, including by--
                            ``(i) making public service announcements 
                        about the warning signs of stroke and the 
                        importance of treating stroke as a medical 
                        emergency; and
                            ``(ii) providing education regarding ways 
                        to prevent stroke and the effectiveness of 
                        stroke treatment; and
                    ``(C) make grants to public and non-profit private 
                entities for medical professional development in 
                accordance with subsection (d).
            ``(3) Regionalization.--With respect to a grantee under 
        this section that is a consortium of States, nothing in this 
        section shall be construed to require each of the member States 
        of such consortium to carry out each of the activities 
        described in subsection (b)(1). In such cases, the member 
        States of the consortium shall allocate the activities 
        described under subsection (b)(1) among the member States of 
        the consortium in such a manner as to best promote the goal of 
        regional cooperation.
    ``(c) Support Network.--A support network described in this 
subsection may include the following:
            ``(1) The use of telehealth technology to connect 
        facilities described in subsection (b)(1)(G) to more advanced 
        stroke care facilities. To the extent practicable, such 
        technology shall be consistent with standards and 
        implementation specifications used for the direct exchange of 
        health information and adopted by the President.
            ``(2) The use of phone consultation, where useful.
            ``(3) The use of referral links when a patient needs more 
        advanced care than is available at the facility providing 
        initial care.
            ``(4) The use of any other assistance determined 
        appropriate by the Secretary.
    ``(d) Medical Professional Development in Advanced Stroke Treatment 
and Prevention.--
            ``(1) In general.--A State or consortia of States may use 
        funds received under a grant under this section to make 
        subgrants to public and non-profit private entities for the 
        development and implementation of education programs for 
        appropriate medical personnel and health professionals in the 
        use of evidence-based diagnostic approaches, technologies, and 
        therapies for the prevention and treatment of stroke.
            ``(2) Use of funds.--A public or non-profit private entity 
        shall use amounts received under a subgrant under this 
        subsection for the continuing education of appropriate medical 
        personnel in the use of evidence-based diagnostic approaches, 
        technologies, and therapies for the prevention and treatment of 
        stroke.
            ``(3) Distribution of subgrants.--In awarding subgrants 
        under this subsection, the Secretary shall ensure that such 
        subgrants are equitably distributed with special consideration 
        given to rural areas or areas that are underserved by medical 
        specialists within a State or consortia of States.
            ``(4) Application.--A public or non-profit private entity 
        desiring a subgrant under this subsection shall prepare and 
        submit to the State or State consortia involved an application 
        at such time, in such manner, and containing such information 
        as the State or State consortia involved may require, including 
        a plan for the rigorous evaluation of activities carried out 
        with amounts received under such a subgrant.
    ``(e) Restrictions on Use of Payments.--The Secretary may not make 
payments to a State or consortia of States under this section for a 
fiscal year unless the State or consortia agrees that the payments will 
not be expended--
            ``(1) to make cash payments to intended recipients of 
        services provided pursuant to this section;
            ``(2) to satisfy any requirement for the expenditure of 
        non-Federal funds as a condition for the receipt of Federal 
        funds;
            ``(3) to provide financial assistance to any entity other 
        than a public or nonprofit private entity; or
            ``(4) for construction, alteration, or improvement of any 
        building or facility.
    ``(f) Failure To Comply With Agreements.--
            ``(1) Repayment of payments.--
                    ``(A) Requirement.--The Secretary may, in 
                accordance with paragraph (2), require a State or 
                consortia of States to repay any payments received by 
                the State or consortia under this section that the 
                Secretary determines were not expended by the State or 
                consortia in accordance with the agreements required to 
                be made by the State or consortia as a condition of the 
                receipt of payments.
                    ``(B) Offset of amounts.--If a State or consortia 
                of States fails to make a repayment required in 
                subparagraph (A), the Secretary may offset the amount 
                of the repayment against any amount due to be paid to 
                the State or consortia under this section.
            ``(2) Opportunity for a hearing.--Before requiring 
        repayment of payments under paragraph (1), the Secretary shall 
        provide to the State or consortia of States an opportunity for 
        a hearing.
    ``(g) Application Requirements.--The Secretary may not award a 
grant to a State or consortia of States under this section unless--
            ``(1) the State or consortia submits an application 
        containing agreements in accordance with this section;
            ``(2) the agreements are made through certification from 
        the chief executive officer of the State or States involved;
            ``(3) with respect to such agreements, the application 
        provides assurances of compliance satisfactory to the 
        Secretary;
            ``(4) the application contains the plan provisions and the 
        information required to be submitted to the Secretary; and
            ``(5) the application otherwise 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.
    ``(h) Technical Assistance.--The Secretary may, without charge to a 
State or consortia of States receiving payments under this section, 
provide to the State or consortia (or to any public or nonprofit entity 
designated by the State or consortia) technical assistance with respect 
to the planning, development, and operation of any program carried out 
pursuant to this section. The Secretary may provide such technical 
assistance directly, through contract, or through grants.
    ``(i) Supplies and Services in Lieu of Grant Funds.--
            ``(1) In general.--Upon the request of a State or consortia 
        of States receiving payments under this section, the Secretary 
        may, subject to paragraph (2), provide supplies, equipment, and 
        services to the State or consortia and may detail to the State 
        or consortia any officer or employee of the Department of 
        Health and Human Services, for the purpose of assisting the 
        State or consortia to achieve the purpose of the payments.
            ``(2) Reduction in payments.--With respect to a request 
        described in paragraph (1), the Secretary shall reduce the 
        amount of payments to the State or consortia of States under 
        this section by an amount equal to the costs of detailing 
        personnel and the fair market value of any supplies, equipment, 
        or services provided by the Secretary. The Secretary shall, for 
        the payment of expenses incurred in complying with such 
        request, expend the amounts withheld.
    ``(j) Report.--Not later than 3 years after the date of the 
enactment of the Stroke Treatment and Ongoing Prevention Act of 2007, 
the Secretary may report to the appropriate committees of the Congress 
on the activities of the States or consortia of States carried out 
pursuant to this section and section 399KK. Such report shall include 
an assessment of the extent to which Federal and State efforts to 
identify stroke centers, develop support networks, and enhance 
emergency medical services coordination and the training of emergency 
medical personnel, have increased the number of stroke patients who 
have received acute stroke consultation or therapy within the 
appropriate timeframe and reduced the level of disability due to 
stroke.
    ``(k) Limitation on Administrative Expenses.--The Secretary may not 
award a grant to a State or consortia of States under this section 
unless the State or consortia agrees to use not more than 10 percent of 
amounts received under the grant for administrative expenses.

``SEC. 399KK. SPECIAL CONSIDERATION.

    ``In awarding grants under this subpart, the Secretary may give 
special consideration to any State or consortia of States that has 
submitted an application for carrying out programs under such a grant--
            ``(1) in geographic areas in which there is--
                    ``(A) an elevated incidence or prevalence of 
                disability resulting from stroke;
                    ``(B) an elevated incidence or prevalence of 
                stroke; or
                    ``(C) a rural area or area that is underserved by 
                medical specialists;
            ``(2) that demonstrates a significant need for assistance 
        in establishing a comprehensive stroke care system; or
            ``(3) that in the determination of the Secretary, will 
        enhance regional cooperation.

                   ``Subpart III--General Provisions

``SEC. 399LL. GENERAL PROVISIONS.

    ``(a) Consultations.--In carrying out this part, the Secretary may 
consult with organizations and individuals with expertise in stroke 
prevention, diagnosis, treatment, and rehabilitation.
    ``(b) Requirement of Matching Funds.--
            ``(1) In general.--The Secretary may not make a grant under 
        this part unless the State (or consortia of States) involved 
        agrees, with respect to the costs to be incurred by the State 
        (or consortia) in carrying out the purpose for which such grant 
        was made, to make available non-Federal contributions (in cash 
        or in kind under paragraph (2)) toward such costs in an amount 
        equal to not less than $1 for each $3 of Federal funds provided 
        in the grant. Such contributions may be made directly or 
        through donations from public or private entities.
            ``(2) Determination of amount of non-federal 
        contribution.--
                    ``(A) In general.--Non-Federal contributions 
                required in paragraph (1) may be in cash or in kind, 
                fairly evaluated, including equipment or services (and 
                excluding indirect or overhead costs). Amounts provided 
                by the Federal Government, or services assisted or 
                subsidized to any significant extent by the Federal 
                Government, may not be included in determining the 
                amount of such non-Federal contributions.
                    ``(B) Maintenance of effort.--In making a 
                determination of the amount of non-Federal 
                contributions for purposes of paragraph (1), the 
                Secretary may include only non-Federal contributions in 
                excess of the average amount of non-Federal 
                contributions made by the State (or consortia) involved 
                toward the purpose for which the grant was made for the 
                2-year period preceding the first fiscal year for which 
                the State (or consortia) is applying to receive a grant 
                under this part.
    ``(c) Supplement Not Supplant.--Amounts appropriated under this 
section shall be used to supplement and not supplant other Federal, 
State, and local public funds provided for activities under this part.
    ``(d) Definitions.--In this part:
            ``(1) State.--The term `State' means each of the several 
        States, the District of Columbia, the Commonwealth of Puerto 
        Rico, the Indian tribes, the Virgin Islands, Guam, American 
        Samoa, and the Commonwealth of the Northern Mariana Islands.
            ``(2) Stroke care system.--The term `stroke care system' 
        means a statewide system to provide for the diagnosis, 
        prehospital care, hospital definitive care, and rehabilitation 
        of stroke patients.
            ``(3) Stroke.--The term `stroke' means a `brain attack' in 
        which blood flow to the brain is interrupted or in which a 
        blood vessel or aneurysm in the brain breaks or ruptures.
    ``(e) Authorization of Appropriations.--There are authorized to be 
appropriated to carry out this part such sums as may be necessary for 
fiscal years 2008 through 2012.''.
                                                       Calendar No. 699

110th CONGRESS

  2d Session

                                 S. 999

_______________________________________________________________________

                                 A BILL

 To amend the Public Health Service Act to improve stroke prevention, 
               diagnosis, treatment, and rehabilitation.

_______________________________________________________________________

                             April 16, 2008

                       Reported with an amendment
```