II

107TH CONGRESS

1ST SESSION S. 1274

To amend the Public Health Service Act to provide programs for the

prevention, treatment, and rehabilitation of stroke.

IN THE SENATE OF THE UNITED STATES

JULY 31, 2001

Mr. KENNEDY (for himself, Mr. FRIST, Mr. DODD, Mr. HUTCHINSON, Mr.

JEFFORDS, Ms. COLLINS, Mr. BINGAMAN, Mr. EDWARDS, Mrs. MURRAY,

and Mr. SESSIONS) introduced the following bill; which was read twice

and referred to the Committee on Health, Education, Labor, and Pensions

A BILL

To amend the Public Health Service Act to provide programs

for the prevention, treatment, and rehabilitation of stroke.

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 of 2001’’.

6 SEC. 2. FINDINGS AND GOAL.

7 (a) FINDINGS.—Congress makes the following find8 ings:
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1 (1) Stroke is the third leading cause of death

2 in the United States. Each year over 750,000 Amer3 icans suffer a new or recurrent stroke and 160,000

4 Americans die from stroke.

5 (2) Stroke costs the United States

6 $28,000,000,000 in direct costs and

7 $17,400,000,000 in indirect costs, each year.

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

9 disability in the United States. Between 15 percent

10 and 30 percent of stroke survivors are permanently

11 disabled. Presently, there are 4,400,000 stroke sur12 vivors living in the United States.

13 (4) Members of the general public have dif14 ficulty recognizing the symptoms of stroke and are

15 unaware that stroke is a medical emergency. Fifty16 eight percent of all stroke patients wait 24 hours or

17 more before presenting at the emergency room.

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

19 do not recognize numbness or paralysis in the face,

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

21 them cannot name a single stroke symptom.

22 (5) Recent advances in stroke treatment can

23 significantly improve the outcome for stroke pa24 tients, but these therapies must be administered

25 properly and promptly. Only 3 percent of stroke pa-
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1 tients who are candidates for acute stroke intra2 venous thrombolytic drug therapy receive the appro3 priate medication.

4 (6) New technologies, therapies, and diagnostic

5 approaches are currently being developed that will

6 extend the therapeutic timeframe and result in

7 greater treatment efficacy for stroke patients.

8 (7) Few States and communities have developed

9 and implemented stroke awareness programs, pre10 vention programs, or comprehensive stroke care sys11 tems.

12 (8) The degree of disability resulting from

13 stroke can be reduced substantially by educating the

14 general public about stroke and by improving the

15 systems for the provision of stroke care in the

16 United States.

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

18 provision of stroke care in every State and territory and

19 in the District of Columbia, and to increase public aware20 ness about the prevention, detection, and treatment of

21 stroke.

22 SEC. 3. SYSTEMS FOR STROKE PREVENTION, TREATMENT,

23 AND REHABILITATION.

24 The Public Health Service Act (42 U.S.C. 201 et

25 seq.) is amended by adding at the end the following:
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1 ‘‘TITLE XXVIII—SYSTEMS FOR

2 STROKE PREVENTION,

3 TREATMENT, AND REHABILI4 TATION

5 ‘‘PART A—STROKE PREVENTION AND EDUCATION

6 CAMPAIGN

7 ‘‘SEC. 2801. STROKE PREVENTION AND EDUCATION CAM8 PAIGN.

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

10 national education and information campaign to promote

11 stroke prevention and increase the number of stroke pa12 tients who seek immediate treatment. In implementing

13 such education and information campaign, the Secretary

14 shall avoid duplicating existing stroke education efforts by

15 other Federal Government agencies and may consult with

16 national and local associations that are dedicated to in17 creasing the public awareness of stroke, consumers of

18 stroke awareness products, and providers of stroke care.

19 ‘‘(b) USE OF FUNDS.—The Secretary may use

20 amounts appropriated to carry out the campaign described

21 in subsection (a)—

22 ‘‘(1) to make public service announcements

23 about the warning signs of stroke and the impor24 tance of treating stroke as a medical emergency;
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1 ‘‘(2) to provide education regarding ways to

2 prevent stroke and the effectiveness of stroke treat3 ment;

4 ‘‘(3) to purchase media time and space;

5 ‘‘(4) to pay for out-of-pocket advertising pro6 duction costs;

7 ‘‘(5) to test and evaluate advertising and edu8 cational materials for effectiveness, especially among

9 groups at high risk for stroke, including women,

10 older adults, and African-Americans;

11 ‘‘(6) to develop alternative campaigns that are

12 targeted to unique communities, including rural and

13 urban communities, and communities in the ‘Stroke

14 Belt’;

15 ‘‘(7) to measure public awareness prior to the

16 start of the campaign on a national level and in tar17 geted communities to provide baseline data that will

18 be used to evaluate the effectiveness of the public

19 awareness efforts; and

20 ‘‘(8) to carry out other activities that the Sec21 retary determines will promote prevention practices

22 among the general public and increase the number

23 of stroke patients who seek immediate care.

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

25 is authorized to be appropriated to carry out subsection
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1 (b), $40,000,000 for fiscal year 2002, and such sums as

2 may be necessary for each of fiscal years 2003 through

3 2006.

4 ‘‘PART B—GENERAL AUTHORITIES AND DUTIES OF THE

5 SECRETARY

6 ‘‘SEC. 2811. ESTABLISHMENT.

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

8 to stroke care—

9 ‘‘(1) make available, support, and evaluate a

10 grant program to enable a State to develop statewide

11 stroke care systems;

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

13 modern systems of stroke care through the sharing

14 of information among agencies and individuals in15 volved in the study and provision of such care; and

16 ‘‘(3) provide to State and local agencies tech17 nical assistance.

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

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

20 into cooperative agreements and contracts, for the purpose

21 of carrying out subsection (a).
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1 ‘‘SEC. 2812. PAUL COVERDELL NATIONAL ACUTE STROKE

2 REGISTRY AND CLEARINGHOUSE.

3 ‘‘(a) IN GENERAL.—The Secretary shall maintain the

4 Paul Coverdell National Acute Stroke Registry and Clear5 inghouse by—

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

7 data points as well as appropriate benchmarks for

8 analyzing care of acute stroke patients;

9 ‘‘(2) continuing to design and pilot test proto10 types that will measure the delivery of care to pa11 tients with acute stroke in order to provide real-time

12 data and analysis to reduce death and disability

13 from stroke and improve the quality of life for acute

14 stroke survivors;

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

16 modern stroke care systems (including the develop17 ment of policies related to emergency services sys18 tems) through the sharing of information among

19 agencies and individuals involved in planning, fur20 nishing, and studying such systems;

21 ‘‘(4) collecting, compiling, and disseminating in22 formation on the achievements of, and problems ex23 perienced by, State and local agencies and private

24 entities in developing and implementing stroke care

25 systems and, in carrying out this paragraph, giving

26 special consideration to the unique needs of rural fa-
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1 cilities and those facilities with inadequate resources

2 for providing quality prevention, acute treatment,

3 post-acute treatment, and rehabilitation services for

4 stroke patients;

5 ‘‘(5) providing technical assistance relating to

6 stroke care systems to State and local agencies; and

7 ‘‘(6) carrying out any other activities the Sec8 retary determines to be useful to fulfill the purposes

9 of the Paul Coverdell National Acute Stroke Reg10 istry and Clearinghouse.

11 ‘‘(b) RESEARCH ON STROKE.—The Secretary shall,

12 not earlier than 1 year after the date of enactment of the

13 Stroke Treatment and Ongoing Prevention Act of 2001,

14 ensure the availability of published research on stroke or,

15 where necessary, conduct research concerning—

16 ‘‘(1) best practices in the prevention, diagnosis,

17 treatment, and rehabilitation of stroke;

18 ‘‘(2) barriers to access to currently approved

19 stroke prevention, treatment, and rehabilitation serv20 ices;

21 ‘‘(3) barriers to access to newly developed diag22 nostic approaches, technologies, and therapies for

23 stroke patients;

24 ‘‘(4) the effectiveness of existing public aware25 ness campaigns regarding stroke; and
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1 ‘‘(5) disparities in the prevention, diagnosis,

2 treatment, and rehabilitation of stroke among dif3 ferent populations.

4 ‘‘(c) CERTAIN RESEARCH ACTIVITIES.—In carrying

5 out the activities described in subsection (b), the Secretary

6 may conduct—

7 ‘‘(1) studies with respect to all phases of stroke

8 care, including prehospital, acute, post-acute and re9 habilitation care;

10 ‘‘(2) studies with respect to patient access to

11 currently approved and newly developed stroke pre12 vention and treatment services, including a review of

13 the effect of coverage, coding, and reimbursement

14 practices on access;

15 ‘‘(3) studies with respect to the effect of exist16 ing public awareness campaigns on stroke; and

17 ‘‘(4) any other studies that the Secretary deter18 mines are necessary or useful to conduct a thorough

19 and effective research program regarding stroke.

20 ‘‘(d) MECHANISMS OF SUPPORT.—In carrying out

21 the activities described in subsection (b), the Secretary

22 may make grants to public and private non-profit entities.

23 ‘‘(e) COORDINATION OF EFFORT.—The Secretary

24 shall ensure the adequate coordination of the activities

25 carried out under this section.
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1 ‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—There

2 is authorized to be appropriated such sums as may be nec3 essary for each of fiscal years 2002 through 2006 to carry

4 out this section.

5 ‘‘PART C—GRANTS WITH RESPECT TO STATE STROKE

6 CARE SYSTEMS

7 ‘‘SEC. 2821. ESTABLISHMENT OF PROGRAM FOR IMPROV8 ING STROKE CARE.

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

10 States for the purpose of establishing statewide stroke pre11 vention, treatment, and rehabilitation systems.

12 ‘‘(b) USE OF FUNDS.—

13 ‘‘(1) IN GENERAL.—The Secretary shall make

14 available grants under subsection (a) for the devel15 opment and implementation of statewide stroke care

16 systems that provide stroke prevention services and

17 quality acute, post-acute, and rehabilitation care for

18 stroke patients through the development of sufficient

19 resources and infrastructure, including personnel

20 with appropriate training, acute stroke teams, equip21 ment, and procedures necessary to prevent stroke

22 and to treat and rehabilitate stroke patients. In de23 veloping and implementing statewide stroke care sys24 tems, each State that is awarded such a grant

25 shall—
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1 ‘‘(A) oversee the design and implementa2 tion of the statewide stroke care system;

3 ‘‘(B) enhance, develop, and implement

4 model curricula for training emergency medical

5 services personnel, including dispatchers, first

6 responders, emergency medical technicians, and

7 paramedics in the identification, assessment,

8 stabilization, and prehospital treatment of

9 stroke patients;

10 ‘‘(C) ensure that stroke patients in the

11 State have access to quality care that is con12 sistent with the standards established by the

13 Secretary under section 2823(c);

14 ‘‘(D) establish a support network to pro15 vide assistance to facilities with smaller popu16 lations of stroke patients or less advanced on17 site stroke treatment resources; and

18 ‘‘(E) carry out any other activities that the

19 State-designated agency determines are useful

20 or necessary for the implementation of the

21 statewide stroke care system.

22 ‘‘(2) ACCESS TO CARE.—A State may meet the

23 requirement of paragraph (1)(C) by—

24 ‘‘(A) identifying acute stroke centers with

25 personnel, equipment, and procedures adequate
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1 to provide quality treatment to patients in the

2 acute phase of stroke consistent with the stand3 ards established by the Secretary under section

4 2823(c);

5 ‘‘(B) identifying comprehensive stroke cen6 ters with advanced personnel, equipment, and

7 procedures to prevent stroke and to treat stroke

8 patients in the acute and post-acute phases of

9 stroke and to provide assistance to area facili10 ties with less advanced stroke treatment re11 sources;

12 ‘‘(C) identifying stroke rehabilitation cen13 ters with personnel, equipment, and procedures

14 to provide quality rehabilitative care to stroke

15 patients consistent with the standards estab16 lished by the Secretary under section 2823(c);

17 or

18 ‘‘(D) carrying out any other activities that

19 the designated State agency determines are nec20 essary or useful.

21 ‘‘(3) SUPPORT NETWORK.—A facility that pro22 vides care to stroke patients and that receives sup23 port through a support network established under

24 paragraph (1)(E) shall meet the standards and re25 quirements outlined by the State application under
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1 paragraphs (4), (5), (6), (7), and (8) of section

2 2823(a). The support network may include—

3 ‘‘(A) the use of telehealth technology con4 necting facilities described in such paragraph to

5 more advanced stroke care facilities;

6 ‘‘(B) the provision of neuroimaging, lab,

7 and any other equipment necessary to facilitate

8 the establishment of a telehealth network;

9 ‘‘(C) the use of phone consultation, where

10 useful;

11 ‘‘(D) the use of referral links when a pa12 tient needs more advanced care than is avail13 able at the facility providing initial care; and

14 ‘‘(E) any other assistance determined ap15 propriate by the State.

16 ‘‘(c) PLANNING GRANTS.—

17 ‘‘(1) IN GENERAL.—The Secretary may award

18 a grant to a State to assist such State in formu19 lating a plan to develop a statewide stroke care sys20 tem or in otherwise meeting the conditions described

21 in subsection (b) with respect to a grant under this

22 section.

23 ‘‘(2) SUBMISSION TO SECRETARY.—The gov24 ernor of a State that receives a grant under para25 graph (1) shall submit to the Secretary a copy of the
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1 plan developed using the amounts provided under

2 such grant. Such plan shall be submitted to the Sec3 retary as soon as practicable after the plan has been

4 developed.

5 ‘‘(3) SINGLE GRANT LIMITATION.—To be eligi6 ble to receive a grant under paragraph (1), a State

7 shall not have previously received a grant under such

8 paragraph.

9 ‘‘(d) MODEL CURRICULUM.—

10 ‘‘(1) DEVELOPMENT.—The Secretary shall de11 velop a model curriculum for training emergency

12 medical services personnel, including dispatchers,

13 first responders, emergency medical technicians, and

14 paramedics in the identification, assessment, sta15 bilization, and prehospital treatment of stroke pa16 tients.

17 ‘‘(2) IMPLEMENTATION.—The model curriculum

18 developed under paragraph (1) may be implemented

19 by a State to fulfill the requirements of subsection

20 (b)(1)(B).

21 ‘‘SEC. 2822. REQUIREMENT OF MATCHING FUNDS FOR FIS22 CAL YEARS SUBSEQUENT TO FIRST FISCAL

23 YEAR OF PAYMENTS.

24 ‘‘(a) NON-FEDERAL CONTRIBUTIONS.—
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1 ‘‘(1) IN GENERAL.—The Secretary may not

2 award grants under section 2821(a) unless the State

3 involved agrees, with respect to the costs described

4 in paragraph (2), to make available for each year

5 during which the State receives funding under such

6 section, non-Federal contributions (in cash or in

7 kind under subsection (b)(1)) toward such costs in

8 an amount equal to—

9 ‘‘(A) for the second and third fiscal years

10 of such payments to the State, not less than $1

11 for each $3 of Federal funds provided in such

12 payments for each such fiscal year;

13 ‘‘(B) for the fourth fiscal year of such pay14 ments to the State, not less than $1 for each

15 $2 of Federal funds provided in such payments

16 for such fiscal year; and

17 ‘‘(C) for any subsequent fiscal year of such

18 payments to the State, not less than $1 for

19 each $1 of Federal funds provided in such pay20 ments for such fiscal year.

21 ‘‘(2) PROGRAM COSTS.—The costs referred to

22 in paragraph (1) are the costs to be incurred by the

23 State in carrying out the purpose described in sec24 tion 2821(b).
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1 ‘‘(3) INITIAL YEAR OF PAYMENTS.—The Sec2 retary may not require a State to make non-Federal

3 contributions as a condition of receiving payments

4 under section 2821(a) for the first fiscal year of

5 such payments to the State.

6 ‘‘(b) DETERMINATION OF AMOUNT OF NON-FED7 ERAL CONTRIBUTIONS.—With respect to compliance

8 under subsection (a) as a condition of receiving payments

9 under section 2811(a)—

10 ‘‘(1) a State may make the non-Federal con11 tributions required in such subsection in cash or in

12 kind, fairly evaluated, including plant, equipment, or

13 services; and

14 ‘‘(2) the Secretary may not, in making a deter15 mination of the amount of non-Federal contribu16 tions, include amounts provided by the Federal Gov17 ernment or services assisted or subsidized by a sig18 nificant extent by the Federal Government.

19 ‘‘SEC. 2823. APPLICATION REQUIREMENTS.

20 ‘‘(a) REQUIREMENT OF APPLICATION.—The Sec21 retary may not award a grant to a State under section

22 2821(b) unless an application for the grant is submitted

23 by the State to the Secretary.

24 ‘‘(b) APPLICATION PROCESS AND GUIDELINES.—The

25 Secretary shall provide for an application process and de-
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1 velop guidelines to assist States in submitting an applica2 tion under this section that—

3 ‘‘(1) outlines the stroke care system and ex4 plains how such system will ensure that stroke pa5 tients throughout the State have access to quality

6 care in all phases of stroke, consistent with the

7 standards established by the Secretary under sub8 section (c);

9 ‘‘(2) contains standards and requirements for

10 facilities in the State that provide basic preventive

11 services, advanced preventive services, acute stroke

12 care, post-acute stroke care, and rehabilitation serv13 ices to stroke patients; and

14 ‘‘(3) provides for the establishment of a central

15 data reporting and analysis system and for the col16 lection of data from each facility that will provide di17 rect care to stroke patients in the State—

18 ‘‘(A) to identify the number of stroke pa19 tients treated in the State;

20 ‘‘(B) to monitor patient care in the State

21 for stroke patients at all phases of stroke for

22 the purpose of evaluating the diagnosis, treat23 ment, and treatment outcome of such stroke

24 patients;
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1 ‘‘(C) to identify the total amount of un2 compensated and under-compensated stroke

3 care expenditures for each fiscal year by each

4 stroke care facility in the State;

5 ‘‘(D) to identify the number of acute

6 stroke patients who receive advanced drug ther7 apy;

8 ‘‘(E) to identify patients transferred within

9 the statewide stroke care system, including rea10 sons for such transfer; and

11 ‘‘(F) to communicate to the greatest extent

12 practicable with the Paul Coverdell National

13 Acute Stroke Registry and Clearinghouse.

14 ‘‘(b) CERTAIN STANDARDS WITH RESPECT TO

15 STATEWIDE STROKE CARE SYSTEM.—

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

17 award a grant to a State under section 2821(a) for

18 a fiscal year unless the State agrees that, in car19 rying out paragraphs (2) and (3), the State will—

20 ‘‘(A) adopt standards of care for stroke pa21 tients in the acute, post-acute, and rehabilita22 tion phases of stroke; and

23 ‘‘(B) in adopting the standards described

24 in subparagraph (A)—
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1 ‘‘(i) consult with medical, surgical,

2 and nursing specialty groups, hospital as3 sociations, voluntary health organizations,

4 State offices of rural health, emergency

5 medical services State and local directors,

6 experts in the use of telecommunications

7 technology to provide stroke care, con8 cerned advocates, and other interested par9 ties;

10 ‘‘(ii) conduct hearings on the proposed

11 standards providing adequate notice to the

12 public concerning such hearing; and

13 ‘‘(iii) beginning in fiscal year 2004,

14 take into account the national standards of

15 care.

16 ‘‘(2) QUALITY OF STROKE CARE.—The highest

17 quality of stroke care shall be the primary goal of

18 the State standards adopted under this subsection.

19 ‘‘(3) APPROVAL BY SECRETARY.—The Sec20 retary may not make payments to a State under sec21 tion 2821(a) if the Secretary determines that—

22 ‘‘(A) the State has not taken into account

23 national standards in adopting standards under

24 this subsection;
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1 ‘‘(B) in the case of payments for fiscal

2 year 2004 and subsequent fiscal years, the

3 State has not, in adopting such standards,

4 taken into account the national standards of

5 care and the model system plan developed

6 under subsection (c); or

7 ‘‘(C) in the case of payments for fiscal

8 year 2004 and subsequent fiscal years, the

9 State has not provided to the Secretary the in10 formation received by the State pursuant to

11 paragraphs (9) and (10) of subsection (a).

12 ‘‘(c) MODEL STROKE CARE SYSTEM PLAN.—Not

13 later than 1 year after the date of enactment of the Stroke

14 Treatment and Ongoing Prevention Act of 2001, the Sec15 retary shall develop standards of care for stroke patients

16 in all phases of stroke that may be adopted for guidance

17 by the State and a model plan for the establishment of

18 statewide stroke care systems. Such plan shall—

19 ‘‘(1) take into account national standards;

20 ‘‘(2) take into account existing State systems

21 and plans; and

22 ‘‘(3) take into account the unique needs of

23 urban and rural communities, different regions of

24 the Nation, and States with varying degrees of es25 tablished stroke care infrastructures;
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1 ‘‘SEC. 2824. REQUIREMENT OF SUBMISSION OF APPLICA2 TION CONTAINING CERTAIN AGREEMENTS

3 AND ASSURANCES.

4 ‘‘The Secretary may not award grants under section

5 2821(a) to a State for a fiscal year unless—

6 ‘‘(1) the State submits an application for the

7 payments containing agreements in accordance with

8 this part;

9 ‘‘(2) the agreements are made through certifi10 cation from the chief executive officer of the State;

11 ‘‘(3) with respect to such agreements, the appli12 cation provides assurances of compliance satisfactory

13 to the Secretary;

14 ‘‘(4) the application contains the plan provi15 sions and the information required to be submitted

16 to the Secretary pursuant to section 2823; and

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

18 is made in such manner, and contains such agree19 ments, assurances, and information as the Secretary

20 determines to be necessary to carry out this part.

21 ‘‘SEC. 2825. RESTRICTIONS ON USE OF PAYMENTS.

22 ‘‘(a) IN GENERAL.—The Secretary may not, except

23 as provided in subsection (b), make payments to a State

24 under section 2821(a) for a fiscal year unless the State

25 involved agrees that the payments will not be expended—
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1 ‘‘(1) to make cash payments to intended recipi2 ents of services provided pursuant to such section;

3 ‘‘(2) to satisfy any requirement for the expendi4 ture of non-Federal funds as a condition for the re5 ceipt of Federal funds; or

6 ‘‘(3) to provide financial assistance to any enti7 ty other than a public or nonprofit private entity.

8 ‘‘(b) EXCEPTION.—If the Secretary finds that the

9 purpose described in section 2821(b) cannot otherwise be

10 carried out, the Secretary may, with respect to an other11 wise qualified State, waive the restriction established in

12 subsection (a)(3).

13 ‘‘SEC. 2826. FAILURE TO COMPLY WITH AGREEMENTS.

14 ‘‘(a) REPAYMENT OF PAYMENTS.—

15 ‘‘(1) REQUIREMENT.—The Secretary may, in

16 accordance with subsection (b), require a State to

17 repay any payments received by the State pursuant

18 to section 2821(a) that the Secretary determines

19 were not expended by the State in accordance with

20 the agreements required to be made by the State as

21 a condition of the receipt of payments under such

22 section.

23 ‘‘(2) OFFSET OF AMOUNTS.—If a State fails to

24 make a repayment required in paragraph (1), the

25 Secretary may offset the amount of the repayment
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1 against any amount due to be paid to the State

2 under section 2821(a).

3 ‘‘(b) OPPORTUNITY FOR A HEARING.—Before requir4 ing repayment of payments under subsection (a)(1), the

5 Secretary shall provide to the State an opportunity for a

6 hearing.

7 ‘‘SEC. 2827. SPECIAL CONSIDERATION.

8 ‘‘In awarding grants under this part, the Secretary

9 shall give special consideration to any State that has sub10 mitted an application for carrying out programs under

11 such a grant—

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

13 ‘‘(A) a substantial rate of disability result14 ing from stroke; or

15 ‘‘(B) a substantial incidence of stroke; or

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

17 assistance in establishing a comprehensive stroke

18 care system.

19 ‘‘SEC. 2828. TECHNICAL ASSISTANCE AND PROVISION BY

20 SECRETARY OF SUPPLIES AND SERVICES IN

21 LIEU OF GRANT FUNDS.

22 ‘‘(a) TECHNICAL ASSISTANCE.—The Secretary shall,

23 without charge to a State receiving payments under sec24 tion 2821(a), provide to the State (or to any public or

25 nonprofit entity designated by the State) technical assist-
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1 ance with respect to the planning, development, and oper2 ation of any program carried out pursuant to section

3 2821(b). The Secretary may provide such technical assist4 ance directly, through contract, or through grants.

5 ‘‘(b) PROVISION BY SECRETARY OF SUPPLIES AND

6 SERVICES IN LIEU OF GRANT FUNDS.—

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

8 State receiving payments under section 2821(a), the

9 Secretary may, subject to paragraph (2), provide

10 supplies, equipment, and services for the purpose of

11 aiding the State in carrying out section 2821(b) and,

12 for such purpose, may detail to the State any officer

13 or employee of the Department of Health and

14 Human Services.

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

16 to a request described in paragraph (1), the Sec17 retary shall reduce the amount of payments to the

18 State under section 2821(a) by an amount equal to

19 the costs of detailing personnel and the fair market

20 value of any supplies, equipment, or services pro21 vided by the Secretary. The Secretary shall, for the

22 payment of expenses incurred in complying with

23 such request, expend the amounts withheld.
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1 ‘‘SEC. 2829. REPORT BY SECRETARY.

2 ‘‘Not later than 3 years after the date of enactment

3 of the Stroke Treatment and Ongoing Prevention Act of

4 2001, the Secretary shall report to the appropriate com5 mittees of Congress on the activities of the States carried

6 out pursuant to section 2821. Such report shall include

7 an assessment of the extent to which Federal and State

8 efforts to develop stroke care systems, including the estab9 lishment of support networks and the identification of

10 acute, comprehensive, and rehabilitation stroke centers,

11 where applicable, have increased the number of stroke pa12 tients who have received acute stroke consultation or ther13 apy within the appropriate timeframe and reduced the

14 level of disability due to stroke. Such report may include

15 any recommendations of the Secretary for appropriate ad16 ministrative and legislative initiatives with respect to

17 stroke care.

18 ‘‘SEC. 2830. FUNDING.

19 ‘‘(a) AUTHORIZATION OF APPROPRIATIONS.—There

20 is authorized to be appropriated to carry out this part,

21 $50,000,000 for fiscal year 2002, $75,000,000 for fiscal

22 year 2003, $75,000,000 for fiscal year 2004,

23 $100,000,000 for fiscal year 2005, and $125,000,000 for

24 fiscal year 2006.

25 ‘‘(b) LIMITATION ON ADMINISTRATIVE EXPENSES.—

26 A State may use not to exceed 10 percent of amounts re-
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1 ceived under a grant awarded under section 2821(a) for

2 administrative expenses.

3 ‘‘PART D—MISCELLANEOUS PROGRAMS

4 ‘‘SEC. 2831. MEDICAL PROFESSIONAL DEVELOPMENT IN AD5 VANCED STROKE TREATMENT AND PREVEN6 TION.

7 ‘‘(a) IN GENERAL.—The Secretary may make grants

8 to public and non-profit private entities for the develop9 ment and implementation of education programs for ap10 propriate medical personnel including medical students,

11 emergency physicians, primary care providers, neurolo12 gists, neurosurgeons, and physical therapists in the use

13 of newly developed diagnostic approaches, technologies,

14 and therapies for the prevention and treatment of stroke.

15 ‘‘(b) DISTRIBUTION OF GRANTS.—In awarding

16 grants under subsection (a), the Secretary shall ensure

17 that such grants are equitably distributed among the geo18 graphical regions of the United States and between urban

19 and rural populations.

20 ‘‘(c) APPLICATION.—A public or non-profit private

21 entity desiring a grant under subsection (a) shall prepare

22 and submit to the Secretary an application at such time,

23 in such manner, and containing such information as the

24 Secretary may require, including a plan for the rigorous
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1 evaluation of activities carried out with amounts received

2 under such a grant.

3 ‘‘(d) USE OF FUNDS.—A public or non-profit private

4 entity shall use amounts received under a grant under this

5 section for the continuing education of appropriate med6 ical personnel in the use of newly developed diagnostic ap7 proaches, technologies, and therapies for the prevention

8 and treatment of stroke.

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

10 is authorized to be appropriated to carry out this section,

11 such sums as may be necessary for each of fiscal years

12 2002 through 2006.

13 ‘‘PART E—GENERAL PROVISIONS REGARDING PARTS A,

14 B, C, AND D

15 ‘‘SEC. 2841. DEFINITIONS.

16 ‘‘In this title:

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

18 the several States, the District of Columbia, the

19 Commonwealth of Puerto Rico, the Indian tribes,

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

21 Commonwealth of the Northern Mariana Islands.

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

23 care system’ means a statewide system to provide

24 for the diagnosis, prehospital care, hospital definitive

25 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 ‘‘SEC. 2842. CONSULTATIONS.

6 ‘‘In carrying out this title, the Secretary shall consult

7 with medical, surgical, rehabilitation, and nursing spe8 cialty groups, hospital associations, voluntary health orga9 nizations, emergency medical services, State directors, and

10 associations, experts in the use of telecommunication tech11 nology to provide stroke care, national disability and con12 sumer organizations representing individuals with disabil13 ities and chronic illnesses, concerned advocates, and other

14 interested parties.’’.

Æ