II 

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. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 


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1 SECTION 1. SHORT TITLE. 

2 This Act may be cited as the ‘‘Stroke Treatment and 

3 Ongoing Prevention Act of 2007’’. 

4 SEC. 2. FINDINGS AND GOAL. 

5 (a) FINDINGS.—The Congress finds as follows: 

6 (1) Stroke is the third leading cause of death 

7 in the United States. Each year approximately 

8 700,000 Americans suffer a new or recurrent stroke 

9 and over 160,000 Americans die from stroke. 

10 (2) Stroke costs the United States 

11 $35,000,000,000 in direct costs and 

12 $56,800,000,000 in indirect costs each year. 

13 (3) Stroke is one of the leading causes of adult 

14 disability in the United States. Between 15 percent 

15 and 30 percent of stroke survivors are permanently 

16 disabled. Presently, there are 4,700,000 stroke sur17 vivors living in the United States. 

18 (4) Members of the general public have dif19 ficulty recognizing the symptoms of stroke and are 

20 unaware that stroke is a medical emergency. Fre21 quently, stroke patients wait as many as 22 hours 

22 or more before presenting at the emergency room. 

23 Forty-two percent of individuals over the age of 50 

24 do not recognize numbness or paralysis in the face, 

25 arm, or leg as a sign of stroke and 17 percent of 

26 them cannot name a single stroke symptom. 


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1 (5) Recent advances in stroke treatment can 

2 significantly improve the outcome for stroke pa3 tients, but these therapies must be administered 

4 properly and promptly. Only 3 percent of stroke pa5 tients who are candidates for acute stroke intra6 venous thrombolytic drug therapy receive the appro7 priate medication. 

8 (6) New technologies, therapies, and diagnostic 

9 approaches are currently being developed that will 

10 extend the therapeutic timeframe and result in 

11 greater treatment efficacy for stroke patients. 

12 (7) Few States and communities have developed 

13 and implemented stroke awareness programs, pre14 vention programs, or comprehensive stroke care sys15 tems. 

16 (8) The degree of disability resulting from 

17 stroke can be reduced substantially by educating the 

18 general public about stroke and by improving the 

19 systems for the provision of stroke care in the 

20 United States. 

21 (b) GOAL.—It is the goal of this Act to improve the 

22 provision of stroke care in every State and territory and 

23 in the District of Columbia, and to increase public aware24 ness about the prevention, detection, and treatment of 

25 stroke. 


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1 SEC. 3. AMENDMENT REGARDING STROKE PREVENTION, 

2 TREATMENT, AND REHABILITATION. 

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

4 241 et seq.) is amended by adding at the end the fol5 lowing: 

6 ‘‘PART S—STROKE PREVENTION, TREATMENT, 

7 AND REHABILITATION PROGRAMS 

8 ‘‘Subpart I—Authorities and Duties of the Secretary 

9 ‘‘SEC. 399HH. RESPONSIBILITIES OF THE SECRETARY. 

10 ‘‘(a) IN GENERAL.—The Secretary shall, with respect 

11 to stroke care— 

12 ‘‘(1) establish and evaluate a grant program 

13 under section 399JJ to enable States to develop 

14 statewide stroke care systems; 

15 ‘‘(2) foster the development of appropriate, 

16 modern systems of stroke care through the sharing 

17 of information among agencies and individuals in18 volved in the study and provision of such care; 

19 ‘‘(3) provide to State and local agencies tech20 nical assistance; 

21 ‘‘(4) develop a model curriculum for training 

22 emergency medical services personnel, including dis23 patchers, first responders, emergency medical techni24 cians, and paramedics, in the identification, assess25 ment, stabilization, and prehospital treatment of 

26 stroke patients; 


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1 ‘‘(5) issue recommendations or guidelines on 

2 best practices for the establishment and operation of 

3 statewide stroke systems, including recommendations 

4 or guidelines on best practices for the establishment 

5 and operation of stroke care centers; and 

6 ‘‘(6) provide, to the extent practicable, informa7 tion to the public on the recognition of the signs and 

8 symptoms of stroke and the appropriate actions to 

9 take to assist an individual in obtaining appropriate 

10 and timely care following a stroke. 

11 ‘‘(b) GRANTS, COOPERATIVE AGREEMENTS, AND

12 CONTRACTS.—The Secretary may make grants, and enter 

13 into cooperative agreements and contracts, for the purpose 

14 of carrying out subsection (a). 

15 ‘‘(c) RULES OF CONSTRUCTION.— 

16 ‘‘(1) EXISTING GUIDELINES.—Nothing in sub17 section (a)(5) shall be construed to require the Sec18 retary to issue new recommendations or guidelines 

19 where existing recommendations or guidelines issued 

20 or adopted by the Secretary are applicable to the es21 tablishment of statewide stroke systems. Where an 

22 existing recommendation or guideline is applicable to 

23 the establishment of statewide stroke systems, the 

24 Secretary may deem such recommendation or guide25 line to have been issued under subsection (a)(5). 


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1 ‘‘(2) ADVISORY NATURE OF GUIDELINES.—Rec2 ommendations or guidelines issued under subsection 

3 (a)(5) shall be considered advisory in nature and 

4 shall not be construed to constitute a standard of 

5 care for the treatment of stroke. 

6 ‘‘SEC. 399II. PAUL COVERDELL NATIONAL ACUTE STROKE 

7 REGISTRY. 

8 ‘‘The Secretary shall maintain the Paul Coverdell Na9 tional Acute Stroke Registry by— 

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

11 data points as well as appropriate benchmarks for 

12 analyzing care of acute stroke patients; 

13 ‘‘(2) continuing to develop a national registry 

14 model that measures the delivery of care to patients 

15 with acute stroke in order to provide real-time data 

16 and analysis to reduce death and disability from 

17 stroke and improve the quality of life for acute 

18 stroke survivors; 

19 ‘‘(3) fostering the development of effective, 

20 modern stroke care systems (including the develop21 ment of policies related to emergency services sys22 tems) through the sharing of information among 

23 agencies and individuals involved in planning, fur24 nishing, and studying such systems; 


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1 ‘‘(4) collecting, compiling, and disseminating in2 formation on the achievements of, and problems ex3 perienced by, State and local agencies and private 

4 entities in developing and implementing stroke care 

5 systems and, in carrying out this paragraph, giving 

6 special consideration to the unique needs of rural fa7 cilities and those facilities with inadequate resources 

8 for providing high-quality prevention, acute treat9 ment, post-acute treatment, and rehabilitation serv10 ices for stroke patients; and 

11 ‘‘(5) carrying out any other activities the Sec12 retary determines to be useful to fulfill the purposes 

13 of the Paul Coverdell National Acute Stroke Reg14 istry. 

15 ‘‘Subpart II—State Stroke Care Systems 

16 ‘‘SEC. 399JJ. GRANTS TO STATES FOR STROKE CARE SYS17 TEMS. 

18 ‘‘(a) GRANTS.—The Secretary shall award grants to 

19 States for the development and implementation of stroke 

20 care systems that provide high-quality prevention, diag21 nosis, treatment, and rehabilitation. 

22 ‘‘(b) REQUIRED USES.— 

23 ‘‘(1) IN GENERAL.—In carrying out activities 

24 described in subsection (a), each State that is 

25 awarded a grant under this section shall— 


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1 ‘‘(A) establish, enhance, or expand a state2 wide stroke care system for the purpose of en3 suring access to high-quality stroke prevention, 

4 diagnosis, treatment, and rehabilitation, except 

5 that activities conducted under this subpara6 graph shall be consistent with guidelines or rec7 ommendations issued by the Secretary under 

8 section 399HH(a)(5) to the extent that such 

9 guidelines or recommendations have been 

10 issued; 

11 ‘‘(B) establish, enhance, or expand, as ap12 propriate, stroke care centers, except that ac13 tivities conducted under this subparagraph shall 

14 be consistent with guidelines or recommenda15 tions issued by the Secretary under section 

16 399HH(a)(5), to the extent that such guide17 lines or recommendations have been issued; 

18 ‘‘(C) conduct evaluation activities to mon19 itor clinical outcomes and procedures and to 

20 verify resources, infrastructure, and operations 

21 devoted to stroke care; 

22 ‘‘(D) enhance, develop, and implement 

23 model curricula for training emergency medical 

24 services personnel in the identification, assess25 ment, stabilization, and prehospital treatment 


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1 of stroke patients which may, at the discretion 

2 of the State, consist of or be based on the 

3 model curriculum developed by the Secretary 

4 under section 399HH(a)(4); 

5 ‘‘(E) enhance coordination of emergency 

6 medical services with respect to stroke care; 

7 ‘‘(F) establish, enhance, or improve a cen8 tral data reporting and analysis system de9 scribed in subsection (c); 

10 ‘‘(G) establish, enhance, or improve a sup11 port network described in subsection (d) to pro12 vide assistance to facilities with smaller popu13 lations of stroke patients or less advanced on14 site stroke treatment resources; 

15 ‘‘(H) consult with organizations and indi16 viduals with expertise in stroke prevention, di17 agnosis, treatment, and rehabilitation; and 

18 ‘‘(I) with respect to carrying out subpara19 graph (C) through (H), use the best available 

20 evidence and consensus recommendations of 

21 professional associations. 

22 ‘‘(2) PERMISSIBLE USES.—In developing and 

23 implementing a stroke care system described in 

24 paragraph (1), each State that is awarded a grant 

25 under this section may— 


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1 ‘‘(A) improve existing State stroke preven2 tion programs; 

3 ‘‘(B) conduct a stroke education and infor4 mation campaign, including by— 

5 ‘‘(i) making public service announce6 ments about the warning signs of stroke 

7 and the importance of treating stroke as a 

8 medical emergency; and 

9 ‘‘(ii) providing education regarding 

10 ways to prevent stroke and the effective11 ness of stroke treatment; and 

12 ‘‘(C) make grants to public and non-profit 

13 private entities for medical professional develop14 ment in accordance with subsection (e). 

15 ‘‘(c) CENTRAL DATA REPORTING AND ANALYSIS

16 SYSTEM.—A central data reporting and analysis system 

17 described in this subsection is a system that collects data 

18 from facilities that provide direct care to stroke patients 

19 and uses the data— 

20 ‘‘(1) to identify the number of stroke patients 

21 treated in the State; 

22 ‘‘(2) to monitor patient care in the State for 

23 stroke patients at all phases of stroke for the pur24 pose of evaluating the diagnosis, treatment, and 

25 treatment outcome of such stroke patients; 


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1 ‘‘(3) to identify the total amount of uncompen2 sated and under-compensated stroke care expendi3 tures for each fiscal year by each stroke care facility 

4 in the State; 

5 ‘‘(4) to identify the number of acute stroke pa6 tients who receive advanced drug therapy; 

7 ‘‘(5) to identify patients transferred within the 

8 statewide stroke care system, including reasons for 

9 such transfer; and 

10 ‘‘(6) to communicate to the greatest extent 

11 practicable with the Paul Coverdell National Acute 

12 Stroke Registry. 

13 ‘‘(d) SUPPORT NETWORK.—A support network de14 scribed in this subsection may include the following: 

15 ‘‘(1) The use of telehealth technology to connect 

16 facilities described in subsection (b)(1)(G) to more 

17 advanced stroke care facilities. 

18 ‘‘(2) The provision of neuroimaging, laboratory, 

19 and any other equipment necessary to facilitate the 

20 establishment of a telehealth network. 

21 ‘‘(3) The use of phone consultation, where use22 ful. 

23 ‘‘(4) The use of referral links when a patient 

24 needs more advanced care than is available at the 

25 facility providing initial care. 


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1 ‘‘(5) Any other assistance determined appro2 priate by the State. 

3 ‘‘(e) MEDICAL PROFESSIONAL DEVELOPMENT IN AD4 VANCED STROKE TREATMENT AND PREVENTION.— 

5 ‘‘(1) IN GENERAL.—A State may use funds re6 ceived under a grant under this section to make sub7 grants to public and non-profit private entities for 

8 the development and implementation of education 

9 programs for appropriate medical personnel and 

10 health professionals in the use of newly developed di11 agnostic approaches, technologies, and therapies for 

12 the prevention and treatment of stroke. 

13 ‘‘(2) USE OF FUNDS.—A public or non-profit 

14 private entity shall use amounts received under a 

15 subgrant under this subsection for the continuing 

16 education of appropriate medical personnel in the 

17 use of newly developed diagnostic approaches, tech18 nologies, and therapies for the prevention and treat19 ment of stroke. 

20 ‘‘(3) DISTRIBUTION OF SUBGRANTS.—In 

21 awarding subgrants under this subsection, the Sec22 retary shall ensure that such subgrants are equitably 

23 distributed among the geographical regions of the 

24 State and between urban and rural populations. 


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1 ‘‘(4) APPLICATION.—A public or non-profit pri2 vate entity desiring a subgrant under this subsection 

3 shall prepare and submit to the State involved an 

4 application at such time, in such manner, and con5 taining such information as the State may require, 

6 including a plan for the rigorous evaluation of activi7 ties carried out with amounts received under such a 

8 subgrant. 

9 ‘‘(f) RESTRICTIONS ON USE OF PAYMENTS.—The 

10 Secretary may not, except as provided in paragraph (2), 

11 make payments to a State under this section for a fiscal 

12 year unless the State agrees that the payments will not 

13 be expended— 

14 ‘‘(1) to make cash payments to intended recipi15 ents of services provided pursuant to this section; 

16 ‘‘(2) to satisfy any requirement for the expendi17 ture of non-Federal funds as a condition for the re18 ceipt of Federal funds; 

19 ‘‘(3) to provide financial assistance to any enti20 ty other than a public or nonprofit private entity; or 

21 ‘‘(4) for construction, alteration, or improve22 ment of any building or facility. 

23 ‘‘(g) FAILURE TO COMPLY WITH AGREEMENTS.— 

24 ‘‘(1) REPAYMENT OF PAYMENTS.— 


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1 ‘‘(A) REQUIREMENT.—The Secretary may, 

2 in accordance with paragraph (2), require a 

3 State to repay any payments received by the 

4 State under this section that the Secretary de5 termines were not expended by the State in ac6 cordance with the agreements required to be 

7 made by the State as a condition of the receipt 

8 of payments. 

9 ‘‘(B) OFFSET OF AMOUNTS.—If a State 

10 fails to make a repayment required in subpara11 graph (A), the Secretary may offset the amount 

12 of the repayment against any amount due to be 

13 paid to the State under this section. 

14 ‘‘(2) OPPORTUNITY FOR A HEARING.—Before 

15 requiring repayment of payments under paragraph 

16 (1), the Secretary shall provide to the State an op17 portunity for a hearing. 

18 ‘‘(h) APPLICATION REQUIREMENTS.—The Secretary 

19 may not award a grant to a State under this section un20 less— 

21 ‘‘(1) the State submits an application con22 taining agreements in accordance with this section; 

23 ‘‘(2) the agreements are made through certifi24 cation from the chief executive officer of the State; 


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1 ‘‘(3) with respect to such agreements, the appli2 cation provides assurances of compliance satisfactory 

3 to the Secretary; 

4 ‘‘(4) the application contains the plan provi5 sions and the information required to be submitted 

6 to the Secretary; and 

7 ‘‘(5) the application otherwise is in such form, 

8 is made in such manner, and contains such agree9 ments, assurances, and information as the Secretary 

10 determines to be necessary to carry out this section. 

11 ‘‘(i) TECHNICAL ASSISTANCE.—The Secretary shall, 

12 without charge to a State receiving payments under this 

13 section, provide to the State (or to any public or nonprofit 

14 entity designated by the State) technical assistance with 

15 respect to the planning, development, and operation of any 

16 program carried out pursuant to this section. The Sec17 retary may provide such technical assistance directly, 

18 through contract, or through grants. 

19 ‘‘(j) SUPPLIES AND SERVICES IN LIEU OF GRANT

20 FUNDS.— 

21 ‘‘(1) IN GENERAL.—Upon the request of a 

22 State receiving payments under this section, the Sec23 retary may, subject to paragraph (2), provide sup24 plies, equipment, and services to the State and may 

25 detail to the State any officer or employee of the DeVerDate Aug 31 2005 22:38 Apr 16, 2008 Jkt 069200 PO 00000 Frm 00015 Fmt 6652 Sfmt 6401 E:\BILLS\S999.RS S999

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1 partment of Health and Human Services, for the 

2 purpose of assisting the State to achieve the purpose 

3 of the payments. 

4 ‘‘(2) REDUCTION IN PAYMENTS.—With respect 

5 to a request described in paragraph (1), the Sec6 retary shall reduce the amount of payments to the 

7 State under this section by an amount equal to the 

8 costs of detailing personnel and the fair market 

9 value of any supplies, equipment, or services pro10 vided by the Secretary. The Secretary shall, for the 

11 payment of expenses incurred in complying with 

12 such request, expend the amounts withheld. 

13 ‘‘(k) REPORT.—Not later than 3 years after the date 

14 of the enactment of the Stroke Treatment and Ongoing 

15 Prevention Act of 2007, the Secretary shall report to the 

16 appropriate committees of the Congress on the activities 

17 of the States carried out pursuant to this section and sec18 tion 399KK. Such report shall include an assessment of 

19 the extent to which Federal and State efforts to identify 

20 stroke centers, develop support networks, and enhance 

21 emergency medical services coordination and the training 

22 of emergency medical personnel, have increased the num23 ber of stroke patients who have received acute stroke con24 sultation or therapy within the appropriate timeframe and 

25 reduced the level of disability due to stroke. 


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1 ‘‘(l) LIMITATION ON ADMINISTRATIVE EXPENSES.— 

2 The Secretary may not award a grant to a State under 

3 this section unless the State agrees to use not more than 

4 10 percent of amounts received under the grant for admin5 istrative expenses. 

6 ‘‘SEC. 399KK. PLANNING GRANTS. 

7 ‘‘(a) GRANTS.—The Secretary may award a grant to 

8 a State to assist such State in formulating a plan to de9 velop a stroke care system in accordance with section 

10 399JJ or in otherwise meeting the requirements of such 

11 section. 

12 ‘‘(b) SUBMISSION TO SECRETARY.—The chief execu13 tive officer of a State that receives a grant under this sec14 tion shall submit to the Secretary a copy of the plan devel15 oped using the amounts provided under such grant. Such 

16 plan shall be submitted to the Secretary as soon as prac17 ticable after the plan has been developed. 

18 ‘‘(c) SINGLE GRANT LIMITATION.—A State is not eli19 gible to receive a grant under this section if the State pre20 viously received a grant under this section. 

21 ‘‘SEC. 399LL. SPECIAL CONSIDERATION. 

22 ‘‘In awarding grants under this subpart, the Sec23 retary shall give special consideration to any State that 

24 has submitted an application for carrying out programs 

25 under such a grant— 


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1 ‘‘(1) in geographic areas in which there is— 

2 ‘‘(A) an elevated incidence or prevalence of 

3 disability resulting from stroke; or 

4 ‘‘(B) an elevated incidence or prevalence of 

5 stroke; or 

6 ‘‘(2) that demonstrates a significant need for 

7 assistance in establishing a comprehensive stroke 

8 care system. 

9 ‘‘Subpart III—General Provisions 

10 ‘‘SEC. 399MM. GENERAL PROVISIONS. 

11 ‘‘(a) CONSULTATIONS.—In carrying out this part, the 

12 Secretary shall consult with organizations and individuals 

13 with expertise in stroke prevention, diagnosis, treatment, 

14 and rehabilitation. 

15 ‘‘(b) DEFINITIONS.—In this part: 

16 ‘‘(1) STATE.—The term ‘State’ means each of 

17 the several States, the District of Columbia, the 

18 Commonwealth of Puerto Rico, the Indian tribes, 

19 the Virgin Islands, Guam, American Samoa, and the 

20 Commonwealth of the Northern Mariana Islands. 

21 ‘‘(2) STROKE CARE SYSTEM.—The term ‘stroke 

22 care system’ means a statewide system to provide 

23 for the diagnosis, prehospital care, hospital definitive 

24 care, and rehabilitation of stroke patients. 


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1 ‘‘(3) STROKE.—The term ‘stroke’ means a 

2 ‘brain attack’ in which blood flow to the brain is in3 terrupted or in which a blood vessel or aneurysm in 

4 the brain breaks or ruptures. 

5 ‘‘(c) AUTHORIZATION OF APPROPRIATIONS.—There 

6 are authorized to be appropriated to carry out this part 

7 such sums as may be necessary for fiscal years 2008 

8 through 2012.’’. 

9 SECTION 1. SHORT TITLE. 

10 This Act may be cited as the ‘‘Stroke Treatment and 

11 Ongoing Prevention Act of 2008’’. 

12 SEC. 2. GOAL. 

13 It is the goal of this Act to improve the provision of 

14 stroke care in every State and territory and in the District 

15 of Columbia, and to increase public awareness about the 

16 prevention, detection, and treatment of stroke. 

17 SEC. 3. AMENDMENT REGARDING STROKE PREVENTION, 

18 TREATMENT, AND REHABILITATION. 

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

20 241 et seq.) is amended by adding at the end the following: 


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1 ‘‘PART S—STROKE PREVENTION, TREATMENT, 

2 AND REHABILITATION PROGRAMS 

3 ‘‘Subpart I—Authorities and Duties of the Secretary 

4 ‘‘SEC. 399HH. RESPONSIBILITIES OF THE SECRETARY. 

5 ‘‘(a) IN GENERAL.—The Secretary may, with respect 

6 to stroke care— 

7 ‘‘(1) establish and evaluate a grant program 

8 under section 399JJ to enable States or consortia of 

9 States to develop stroke care systems; 

10 ‘‘(2) foster the development of systems of stroke 

11 care through total quality improvement of health sys12 tems providing primary stroke prevention and identi13 fication, treatment, and rehabilitation of individuals 

14 who experience a stroke; 

15 ‘‘(3) provide to State, consortia of States, and 

16 local agencies technical assistance; and 

17 ‘‘(4) collaborate with appropriate medical and 

18 health professional associations to disseminate evi19 denced-based practices on stroke systems of care. 

20 ‘‘(b) GRANTS, COOPERATIVE AGREEMENTS, AND CON21 TRACTS.—The Secretary may make grants, and enter into 

22 cooperative agreements and contracts, for the purpose of 

23 carrying out subsection (a). 


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1 ‘‘SEC. 399II. SENSE OF THE SENATE CONCERNING THE 

2 PAUL COVERDELL NATIONAL ACUTE STROKE 

3 REGISTRY. 

4 ‘‘It is the sense of the Senate that, as evidenced by the 

5 Paul Coverdell National Acute Stroke Registry, the Sec6 retary considers stroke systems of care when allocating dis7 cretionary funds relating to stroke. 

8 ‘‘Subpart II—State or Consortia of States Stroke Care 

9 Systems 

10 ‘‘SEC. 399JJ. GRANTS TO STATES OR CONSORTIA OF STATES 

11 FOR STROKE CARE SYSTEMS. 

12 ‘‘(a) GRANTS.—The Secretary may award grants to 

13 States or consortia of States for the development and imple14 mentation of stroke care systems that provide high-quality 

15 prevention, diagnosis, treatment, and rehabilitation. 

16 ‘‘(b) REQUIRED USES.— 

17 ‘‘(1) IN GENERAL.—In carrying out activities 

18 described in subsection (a), each State or consortia of 

19 States that is awarded a grant under this section 

20 shall— 

21 ‘‘(A) establish, enhance, or expand a state22 wide stroke care system for the purpose of pro23 moting the total quality improvement of stroke 

24 care consistent with evidence-based practices; 

25 ‘‘(B) establish, enhance, or expand, as ap26 propriate, stroke care centers, except that activiVerDate Aug 31 2005 22:38 Apr 16, 2008 Jkt 069200 PO 00000 Frm 00021 Fmt 6652 Sfmt 6203 E:\BILLS\S999.RS S999

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1 ties conducted under this subparagraph shall be 

2 consistent with evidence-based practices; 

3 ‘‘(C) conduct evaluation activities to mon4 itor clinical outcomes and procedures and mech5 anisms for evaluating the effectiveness of the re6 sources, infrastructure, and operations devoted to 

7 stroke care; 

8 ‘‘(D) enhance, develop, and implement effec9 tive methods for training emergency medical 

10 services personnel in the identification, assess11 ment, stabilization, and prehospital treatment of 

12 stroke patients; 

13 ‘‘(E) enhance coordination of emergency 

14 medical services, ground transportation services, 

15 and air transportation with respect to stroke 

16 care; 

17 ‘‘(F) establish, enhance, or improve a sup18 port network described in subsection (c) to pro19 vide assistance to facilities with smaller popu20 lations of stroke patients or less advanced on-site 

21 stroke treatment resources; 

22 ‘‘(G) consult with organizations and indi23 viduals with expertise in stroke prevention, diag24 nosis, treatment, and rehabilitation; and 


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1 ‘‘(H) with respect to carrying out subpara2 graph (C) through (H), use the best available 

3 evidence and consensus recommendations of pro4 fessional associations. 

5 ‘‘(2) PERMISSIBLE USES.—In developing and 

6 implementing a stroke care system described in para7 graph (1), each State or consortia of States that is 

8 awarded a grant under this section may— 

9 ‘‘(A) improve existing stroke prevention 

10 programs; 

11 ‘‘(B) conduct a stroke education and infor12 mation campaign, including by— 

13 ‘‘(i) making public service announce14 ments about the warning signs of stroke and 

15 the importance of treating stroke as a med16 ical emergency; and 

17 ‘‘(ii) providing education regarding 

18 ways to prevent stroke and the effectiveness 

19 of stroke treatment; and 

20 ‘‘(C) make grants to public and non-profit 

21 private entities for medical professional develop22 ment in accordance with subsection (d). 

23 ‘‘(3) REGIONALIZATION.—With respect to a 

24 grantee under this section that is a consortium of 

25 States, nothing in this section shall be construed to 


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1 require each of the member States of such consortium 

2 to carry out each of the activities described in sub3 section (b)(1). In such cases, the member States of the 

4 consortium shall allocate the activities described 

5 under subsection (b)(1) among the member States of 

6 the consortium in such a manner as to best promote 

7 the goal of regional cooperation. 

8 ‘‘(c) SUPPORT NETWORK.—A support network de9 scribed in this subsection may include the following: 

10 ‘‘(1) The use of telehealth technology to connect 

11 facilities described in subsection (b)(1)(G) to more ad12 vanced stroke care facilities. To the extent practicable, 

13 such technology shall be consistent with standards 

14 and implementation specifications used for the direct 

15 exchange of health information and adopted by the 

16 President. 

17 ‘‘(2) The use of phone consultation, where useful. 

18 ‘‘(3) The use of referral links when a patient 

19 needs more advanced care than is available at the fa20 cility providing initial care. 

21 ‘‘(4) The use of any other assistance determined 

22 appropriate by the Secretary. 

23 ‘‘(d) MEDICAL PROFESSIONAL DEVELOPMENT IN AD24 VANCED STROKE TREATMENT AND PREVENTION.— 


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1 ‘‘(1) IN GENERAL.—A State or consortia of 

2 States may use funds received under a grant under 

3 this section to make subgrants to public and non-prof4 it private entities for the development and implemen5 tation of education programs for appropriate medical 

6 personnel and health professionals in the use of evi7 dence-based diagnostic approaches, technologies, and 

8 therapies for the prevention and treatment of stroke. 

9 ‘‘(2) USE OF FUNDS.—A public or non-profit 

10 private entity shall use amounts received under a 

11 subgrant under this subsection for the continuing edu12 cation of appropriate medical personnel in the use of 

13 evidence-based diagnostic approaches, technologies, 

14 and therapies for the prevention and treatment of 

15 stroke. 

16 ‘‘(3) DISTRIBUTION OF SUBGRANTS.—In award17 ing subgrants under this subsection, the Secretary 

18 shall ensure that such subgrants are equitably distrib19 uted with special consideration given to rural areas 

20 or areas that are underserved by medical specialists 

21 within a State or consortia of States. 

22 ‘‘(4) APPLICATION.—A public or non-profit pri23 vate entity desiring a subgrant under this subsection 

24 shall prepare and submit to the State or State con25 sortia involved an application at such time, in such 


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1 manner, and containing such information as the 

2 State or State consortia involved may require, includ3 ing a plan for the rigorous evaluation of activities 

4 carried out with amounts received under such a 

5 subgrant. 

6 ‘‘(e) RESTRICTIONS ON USE OF PAYMENTS.—The Sec7 retary may not make payments to a State or consortia of 

8 States under this section for a fiscal year unless the State 

9 or consortia agrees that the payments will not be ex10 pended— 

11 ‘‘(1) to make cash payments to intended recipi12 ents of services provided pursuant to this section; 

13 ‘‘(2) to satisfy any requirement for the expendi14 ture of non-Federal funds as a condition for the re15 ceipt of Federal funds; 

16 ‘‘(3) to provide financial assistance to any entity 

17 other than a public or nonprofit private entity; or 

18 ‘‘(4) for construction, alteration, or improvement 

19 of any building or facility. 

20 ‘‘(f) FAILURE TO COMPLY WITH AGREEMENTS.— 

21 ‘‘(1) REPAYMENT OF PAYMENTS.— 

22 ‘‘(A) REQUIREMENT.—The Secretary may, 

23 in accordance with paragraph (2), require a 

24 State or consortia of States to repay any pay25 ments received by the State or consortia under 


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1 this section that the Secretary determines were 

2 not expended by the State or consortia in accord3 ance with the agreements required to be made by 

4 the State or consortia as a condition of the re5 ceipt of payments. 

6 ‘‘(B) OFFSET OF AMOUNTS.—If a State or 

7 consortia of States fails to make a repayment re8 quired in subparagraph (A), the Secretary may 

9 offset the amount of the repayment against any 

10 amount due to be paid to the State or consortia 

11 under this section. 

12 ‘‘(2) OPPORTUNITY FOR A HEARING.—Before re13 quiring repayment of payments under paragraph (1), 

14 the Secretary shall provide to the State or consortia 

15 of States an opportunity for a hearing. 

16 ‘‘(g) APPLICATION REQUIREMENTS.—The Secretary 

17 may not award a grant to a State or consortia of States 

18 under this section unless— 

19 ‘‘(1) the State or consortia submits an applica20 tion containing agreements in accordance with this 

21 section; 

22 ‘‘(2) the agreements are made through certifi23 cation from the chief executive officer of the State or 

24 States involved; 


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1 ‘‘(3) with respect to such agreements, the appli2 cation provides assurances of compliance satisfactory 

3 to the Secretary; 

4 ‘‘(4) the application contains the plan provisions 

5 and the information required to be submitted to the 

6 Secretary; and 

7 ‘‘(5) the application otherwise is in such form, is 

8 made in such manner, and contains such agreements, 

9 assurances, and information as the Secretary deter10 mines to be necessary to carry out this section. 

11 ‘‘(h) TECHNICAL ASSISTANCE.—The Secretary may, 

12 without charge to a State or consortia of States receiving 

13 payments under this section, provide to the State or con14 sortia (or to any public or nonprofit entity designated by 

15 the State or consortia) technical assistance with respect to 

16 the planning, development, and operation of any program 

17 carried out pursuant to this section. The Secretary may 

18 provide such technical assistance directly, through contract, 

19 or through grants. 

20 ‘‘(i) SUPPLIES AND SERVICES IN LIEU OF GRANT

21 FUNDS.— 

22 ‘‘(1) IN GENERAL.—Upon the request of a State 

23 or consortia of States receiving payments under this 

24 section, the Secretary may, subject to paragraph (2), 

25 provide supplies, equipment, and services to the State 


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1 or consortia and may detail to the State or consortia 

2 any officer or employee of the Department of Health 

3 and Human Services, for the purpose of assisting the 

4 State or consortia to achieve the purpose of the pay5 ments. 

6 ‘‘(2) REDUCTION IN PAYMENTS.—With respect to 

7 a request described in paragraph (1), the Secretary 

8 shall reduce the amount of payments to the State or 

9 consortia of States under this section by an amount 

10 equal to the costs of detailing personnel and the fair 

11 market value of any supplies, equipment, or services 

12 provided by the Secretary. The Secretary shall, for the 

13 payment of expenses incurred in complying with such 

14 request, expend the amounts withheld. 

15 ‘‘(j) REPORT.—Not later than 3 years after the date 

16 of the enactment of the Stroke Treatment and Ongoing Pre17 vention Act of 2007, the Secretary may report to the appro18 priate committees of the Congress on the activities of the 

19 States or consortia of States carried out pursuant to this 

20 section and section 399KK. Such report shall include an 

21 assessment of the extent to which Federal and State efforts 

22 to identify stroke centers, develop support networks, and en23 hance emergency medical services coordination and the 

24 training of emergency medical personnel, have increased the 

25 number of stroke patients who have received acute stroke 


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1 consultation or therapy within the appropriate timeframe 

2 and reduced the level of disability due to stroke. 

3 ‘‘(k) LIMITATION ON ADMINISTRATIVE EXPENSES.— 

4 The Secretary may not award a grant to a State or con5 sortia of States under this section unless the State or con6 sortia agrees to use not more than 10 percent of amounts 

7 received under the grant for administrative expenses. 

8 ‘‘SEC. 399KK. SPECIAL CONSIDERATION. 

9 ‘‘In awarding grants under this subpart, the Secretary 

10 may give special consideration to any State or consortia 

11 of States that has submitted an application for carrying 

12 out programs under such a grant— 

13 ‘‘(1) in geographic areas in which there is— 

14 ‘‘(A) an elevated incidence or prevalence of 

15 disability resulting from stroke; 

16 ‘‘(B) an elevated incidence or prevalence of 

17 stroke; or 

18 ‘‘(C) a rural area or area that is under19 served by medical specialists; 

20 ‘‘(2) that demonstrates a significant need for as21 sistance in establishing a comprehensive stroke care 

22 system; or 

23 ‘‘(3) that in the determination of the Secretary, 

24 will enhance regional cooperation. 


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1 ‘‘Subpart III—General Provisions 

2 ‘‘SEC. 399LL. GENERAL PROVISIONS. 

3 ‘‘(a) CONSULTATIONS.—In carrying out this part, the 

4 Secretary may consult with organizations and individuals 

5 with expertise in stroke prevention, diagnosis, treatment, 

6 and rehabilitation. 

7 ‘‘(b) REQUIREMENT OF MATCHING FUNDS.— 

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

9 a grant under this part unless the State (or consortia 

10 of States) involved agrees, with respect to the costs to 

11 be incurred by the State (or consortia) in carrying 

12 out the purpose for which such grant was made, to 

13 make available non-Federal contributions (in cash or 

14 in kind under paragraph (2)) toward such costs in an 

15 amount equal to not less than $1 for each $3 of Fed16 eral funds provided in the grant. Such contributions 

17 may be made directly or through donations from pub18 lic or private entities. 

19 ‘‘(2) DETERMINATION OF AMOUNT OF NON-FED20 ERAL CONTRIBUTION.— 

21 ‘‘(A) IN GENERAL.—Non-Federal contribu22 tions required in paragraph (1) may be in cash 

23 or in kind, fairly evaluated, including equipment 

24 or services (and excluding indirect or overhead 

25 costs). Amounts provided by the Federal Govern26 ment, or services assisted or subsidized to any 


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1 significant extent by the Federal Government, 

2 may not be included in determining the amount 

3 of such non-Federal contributions. 

4 ‘‘(B) MAINTENANCE OF EFFORT.—In mak5 ing a determination of the amount of non-Fed6 eral contributions for purposes of paragraph (1), 

7 the Secretary may include only non-Federal con8 tributions in excess of the average amount of 

9 non-Federal contributions made by the State (or 

10 consortia) involved toward the purpose for which 

11 the grant was made for the 2-year period pre12 ceding the first fiscal year for which the State 

13 (or consortia) is applying to receive a grant 

14 under this part. 

15 ‘‘(c) SUPPLEMENT NOT SUPPLANT.—Amounts appro16 priated under this section shall be used to supplement and 

17 not supplant other Federal, State, and local public funds 

18 provided for activities under this part. 

19 ‘‘(d) DEFINITIONS.—In this part: 

20 ‘‘(1) STATE.—The term ‘State’ means each of the 

21 several States, the District of Columbia, the Common22 wealth of Puerto Rico, the Indian tribes, the Virgin 

23 Islands, Guam, American Samoa, and the Common24 wealth of the Northern Mariana Islands. 


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1 ‘‘(2) STROKE CARE SYSTEM.—The term ‘stroke 

2 care system’ means a statewide system to provide for 

3 the diagnosis, prehospital care, hospital definitive 

4 care, and rehabilitation of stroke patients. 

5 ‘‘(3) STROKE.—The term ‘stroke’ means a ‘brain 

6 attack’ in which blood flow to the brain is interrupted 

7 or in which a blood vessel or aneurysm in the brain 

8 breaks or ruptures. 

9 ‘‘(e) AUTHORIZATION OF APPROPRIATIONS.—There are 

10 authorized to be appropriated to carry out this part such 

11 sums as may be necessary for fiscal years 2008 through 

12 2012.’’. 


pwalker on PROD1PC71 with BILLS
Calendar No. 699 

110TH CONGRESS 

2D SESSION S. 999 

A BILL 

To amend the Public Health Service Act to improve 

habilitation. stroke prevention, diagnosis, treatment, and reAPRIL 16, 2008 

Reported with an amendment 


pwalker on PROD1PC71 with BILLS