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★(Star Print)

Calendar No. 222

107TH CONGRESS

1ST SESSION S. 1274

[Report No. 107–97]

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,

Mr. SESSIONS, Mr. WARNER, Mr. LEAHY, Mr. KERREY, Mr. DORGAN,

Mr. DEWINE, Mr. SHELBY, and Mrs. FEINSTEIN) introduced the following bill; which was read twice and referred to the Committee on

Health, Education, Labor, and Pensions

NOVEMBER 9, 2001

Reported by Mr. KENNEDY, without amendment

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,
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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 2001’’.

4 SEC. 2. FINDINGS AND GOAL.

5 (a) FINDINGS.—Congress makes the following find6 ings:

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

8 in the United States. Each year over 750,000 Amer9 icans suffer a new or recurrent stroke and 160,000

10 Americans die from stroke.

11 (2) Stroke costs the United States

12 $28,000,000,000 in direct costs and

13 $17,400,000,000 in indirect costs, each year.

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

15 disability in the United States. Between 15 percent

16 and 30 percent of stroke survivors are permanently

17 disabled. Presently, there are 4,400,000 stroke sur18 vivors living in the United States.

19 (4) Members of the general public have dif20 ficulty recognizing the symptoms of stroke and are

21 unaware that stroke is a medical emergency. Fifty22 eight percent of all stroke patients wait 24 hours or

23 more before presenting at the emergency room.

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

25 do not recognize numbness or paralysis in the face,
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1 arm, or leg as a sign of stroke and 17 percent of

2 them cannot name a single stroke symptom.

3 (5) Recent advances in stroke treatment can

4 significantly improve the outcome for stroke pa5 tients, but these therapies must be administered

6 properly and promptly. Only 3 percent of stroke pa7 tients who are candidates for acute stroke intra8 venous thrombolytic drug therapy receive the appro9 priate medication.

10 (6) New technologies, therapies, and diagnostic

11 approaches are currently being developed that will

12 extend the therapeutic timeframe and result in

13 greater treatment efficacy for stroke patients.

14 (7) Few States and communities have developed

15 and implemented stroke awareness programs, pre16 vention programs, or comprehensive stroke care sys17 tems.

18 (8) The degree of disability resulting from

19 stroke can be reduced substantially by educating the

20 general public about stroke and by improving the

21 systems for the provision of stroke care in the

22 United States.

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

24 provision of stroke care in every State and territory and

25 in the District of Columbia, and to increase public aware-
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1 ness about the prevention, detection, and treatment of

2 stroke.

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

4 AND REHABILITATION.

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

6 seq.) is amended by adding at the end the following:

7 ‘‘TITLE XXVIII—SYSTEMS FOR

8 STROKE PREVENTION,

9 TREATMENT, AND REHABILI10 TATION

11 ‘‘PART A—STROKE PREVENTION AND EDUCATION

12 CAMPAIGN

13 ‘‘SEC. 2801. STROKE PREVENTION AND EDUCATION CAM14 PAIGN.

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

16 national education and information campaign to promote

17 stroke prevention and increase the number of stroke pa18 tients who seek immediate treatment. In implementing

19 such education and information campaign, the Secretary

20 shall avoid duplicating existing stroke education efforts by

21 other Federal Government agencies and may consult with

22 national and local associations that are dedicated to in23 creasing the public awareness of stroke, consumers of

24 stroke awareness products, and providers of stroke care.
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1 ‘‘(b) USE OF FUNDS.—The Secretary may use

2 amounts appropriated to carry out the campaign described

3 in subsection (a)—

4 ‘‘(1) to make public service announcements

5 about the warning signs of stroke and the impor6 tance of treating stroke as a medical emergency;

7 ‘‘(2) to provide education regarding ways to

8 prevent stroke and the effectiveness of stroke treat9 ment;

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

11 ‘‘(4) to pay for out-of-pocket advertising pro12 duction costs;

13 ‘‘(5) to test and evaluate advertising and edu14 cational materials for effectiveness, especially among

15 groups at high risk for stroke, including women,

16 older adults, and African-Americans;

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

18 targeted to unique communities, including rural and

19 urban communities, and communities in the ‘Stroke

20 Belt’;

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

22 start of the campaign on a national level and in tar23 geted communities to provide baseline data that will

24 be used to evaluate the effectiveness of the public

25 awareness efforts; and
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1 ‘‘(8) to carry out other activities that the Sec2 retary determines will promote prevention practices

3 among the general public and increase the number

4 of stroke patients who seek immediate care.

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

6 is authorized to be appropriated to carry out subsection

7 (b), $40,000,000 for fiscal year 2002, and such sums as

8 may be necessary for each of fiscal years 2003 through

9 2006.

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

11 SECRETARY

12 ‘‘SEC. 2811. ESTABLISHMENT.

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

14 to stroke care—

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

16 grant program to enable a State to develop statewide

17 stroke care systems;

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

19 modern systems of stroke care through the sharing

20 of information among agencies and individuals in21 volved in the study and provision of such care; and

22 ‘‘(3) provide to State and local agencies tech23 nical assistance.

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

25 CONTRACTS.—The Secretary may make grants, and enter
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1 into cooperative agreements and contracts, for the purpose

2 of carrying out subsection (a).

3 ‘‘SEC. 2812. PAUL COVERDELL NATIONAL ACUTE STROKE

4 REGISTRY AND CLEARINGHOUSE.

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

6 Paul Coverdell National Acute Stroke Registry and Clear7 inghouse by—

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

9 data points as well as appropriate benchmarks for

10 analyzing care of acute stroke patients;

11 ‘‘(2) continuing to design and pilot test proto12 types that will measure the delivery of care to pa13 tients with acute stroke in order to provide real-time

14 data and analysis to reduce death and disability

15 from stroke and improve the quality of life for acute

16 stroke survivors;

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

18 modern stroke care systems (including the develop19 ment of policies related to emergency services sys20 tems) through the sharing of information among

21 agencies and individuals involved in planning, fur22 nishing, and studying such systems;

23 ‘‘(4) collecting, compiling, and disseminating in24 formation on the achievements of, and problems ex25 perienced by, State and local agencies and private
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1 entities in developing and implementing stroke care

2 systems and, in carrying out this paragraph, giving

3 special consideration to the unique needs of rural fa4 cilities and those facilities with inadequate resources

5 for providing quality prevention, acute treatment,

6 post-acute treatment, and rehabilitation services for

7 stroke patients;

8 ‘‘(5) providing technical assistance relating to

9 stroke care systems to State and local agencies; and

10 ‘‘(6) carrying out any other activities the Sec11 retary determines to be useful to fulfill the purposes

12 of the Paul Coverdell National Acute Stroke Reg13 istry and Clearinghouse.

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

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

16 Stroke Treatment and Ongoing Prevention Act of 2001,

17 ensure the availability of published research on stroke or,

18 where necessary, conduct research concerning—

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

20 treatment, and rehabilitation of stroke;

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

22 stroke prevention, treatment, and rehabilitation serv23 ices;
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1 ‘‘(3) barriers to access to newly developed diag2 nostic approaches, technologies, and therapies for

3 stroke patients;

4 ‘‘(4) the effectiveness of existing public aware5 ness campaigns regarding stroke; and

6 ‘‘(5) disparities in the prevention, diagnosis,

7 treatment, and rehabilitation of stroke among dif8 ferent populations.

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

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

11 may conduct—

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

13 care, including prehospital, acute, post-acute and re14 habilitation care;

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

16 currently approved and newly developed stroke pre17 vention and treatment services, including a review of

18 the effect of coverage, coding, and reimbursement

19 practices on access;

20 ‘‘(3) studies with respect to the effect of exist21 ing public awareness campaigns on stroke; and

22 ‘‘(4) any other studies that the Secretary deter23 mines are necessary or useful to conduct a thorough

24 and effective research program regarding stroke.
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1 ‘‘(d) MECHANISMS OF SUPPORT.—In carrying out

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

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

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

5 shall ensure the adequate coordination of the activities

6 carried out under this section.

7 ‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—There

8 is authorized to be appropriated such sums as may be nec9 essary for each of fiscal years 2002 through 2006 to carry

10 out this section.

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

12 CARE SYSTEMS

13 ‘‘SEC. 2821. ESTABLISHMENT OF PROGRAM FOR IMPROV14 ING STROKE CARE.

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

16 States for the purpose of establishing statewide stroke pre17 vention, treatment, and rehabilitation systems.

18 ‘‘(b) USE OF FUNDS.—

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

20 available grants under subsection (a) for the devel21 opment and implementation of statewide stroke care

22 systems that provide stroke prevention services and

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

24 stroke patients through the development of sufficient

25 resources and infrastructure, including personnel
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1 with appropriate training, acute stroke teams, equip2 ment, and procedures necessary to prevent stroke

3 and to treat and rehabilitate stroke patients. In de4 veloping and implementing statewide stroke care sys5 tems, each State that is awarded such a grant

6 shall—

7 ‘‘(A) oversee the design and implementa8 tion of the statewide stroke care system;

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

10 model curricula for training emergency medical

11 services personnel, including dispatchers, first

12 responders, emergency medical technicians, and

13 paramedics in the identification, assessment,

14 stabilization, and prehospital treatment of

15 stroke patients;

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

17 State have access to quality care that is con18 sistent with the standards established by the

19 Secretary under section 2823(c);

20 ‘‘(D) establish a support network to pro21 vide assistance to facilities with smaller popu22 lations of stroke patients or less advanced on23 site stroke treatment resources; and

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

25 State-designated agency determines are useful
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1 or necessary for the implementation of the

2 statewide stroke care system.

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

4 requirement of paragraph (1)(C) by—

5 ‘‘(A) identifying acute stroke centers with

6 personnel, equipment, and procedures adequate

7 to provide quality treatment to patients in the

8 acute phase of stroke consistent with the stand9 ards established by the Secretary under section

10 2823(c);

11 ‘‘(B) identifying comprehensive stroke cen12 ters with advanced personnel, equipment, and

13 procedures to prevent stroke and to treat stroke

14 patients in the acute and post-acute phases of

15 stroke and to provide assistance to area facili16 ties with less advanced stroke treatment re17 sources;

18 ‘‘(C) identifying stroke rehabilitation cen19 ters with personnel, equipment, and procedures

20 to provide quality rehabilitative care to stroke

21 patients consistent with the standards estab22 lished by the Secretary under section 2823(c);

23 or
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1 ‘‘(D) carrying out any other activities that

2 the designated State agency determines are nec3 essary or useful.

4 ‘‘(3) SUPPORT NETWORK.—A facility that pro5 vides care to stroke patients and that receives sup6 port through a support network established under

7 paragraph (1)(E) shall meet the standards and re8 quirements outlined by the State application under

9 paragraphs (4), (5), (6), (7), and (8) of section

10 2823(a). The support network may include—

11 ‘‘(A) the use of telehealth technology con12 necting facilities described in such paragraph to

13 more advanced stroke care facilities;

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

15 and any other equipment necessary to facilitate

16 the establishment of a telehealth network;

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

18 useful;

19 ‘‘(D) the use of referral links when a pa20 tient needs more advanced care than is avail21 able at the facility providing initial care; and

22 ‘‘(E) any other assistance determined ap23 propriate by the State.

24 ‘‘(c) PLANNING GRANTS.—
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1 ‘‘(1) IN GENERAL.—The Secretary may award

2 a grant to a State to assist such State in formu3 lating a plan to develop a statewide stroke care sys4 tem or in otherwise meeting the conditions described

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

6 section.

7 ‘‘(2) SUBMISSION TO SECRETARY.—The gov8 ernor of a State that receives a grant under para9 graph (1) shall submit to the Secretary a copy of the

10 plan developed using the amounts provided under

11 such grant. Such plan shall be submitted to the Sec12 retary as soon as practicable after the plan has been

13 developed.

14 ‘‘(3) SINGLE GRANT LIMITATION.—To be eligi15 ble to receive a grant under paragraph (1), a State

16 shall not have previously received a grant under such

17 paragraph.

18 ‘‘(d) MODEL CURRICULUM.—

19 ‘‘(1) DEVELOPMENT.—The Secretary shall de20 velop a model curriculum for training emergency

21 medical services personnel, including dispatchers,

22 first responders, emergency medical technicians, and

23 paramedics in the identification, assessment, sta24 bilization, and prehospital treatment of stroke pa25 tients.
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1 ‘‘(2) IMPLEMENTATION.—The model curriculum

2 developed under paragraph (1) may be implemented

3 by a State to fulfill the requirements of subsection

4 (b)(1)(B).

5 ‘‘SEC. 2822. REQUIREMENT OF MATCHING FUNDS FOR FIS6 CAL YEARS SUBSEQUENT TO FIRST FISCAL

7 YEAR OF PAYMENTS.

8 ‘‘(a) NON-FEDERAL CONTRIBUTIONS.—

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

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

11 involved agrees, with respect to the costs described

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

13 during which the State receives funding under such

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

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

16 an amount equal to—

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

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

19 for each $3 of Federal funds provided in such

20 payments for each such fiscal year;

21 ‘‘(B) for the fourth fiscal year of such pay22 ments to the State, not less than $1 for each

23 $2 of Federal funds provided in such payments

24 for such fiscal year; and
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1 ‘‘(C) for any subsequent fiscal year of such

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

3 each $1 of Federal funds provided in such pay4 ments for such fiscal year.

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

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

7 State in carrying out the purpose described in sec8 tion 2821(b).

9 ‘‘(3) INITIAL YEAR OF PAYMENTS.—The Sec10 retary may not require a State to make non-Federal

11 contributions as a condition of receiving payments

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

13 such payments to the State.

14 ‘‘(b) DETERMINATION OF AMOUNT OF NON-FED15 ERAL CONTRIBUTIONS.—With respect to compliance

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

17 under section 2811(a)—

18 ‘‘(1) a State may make the non-Federal con19 tributions required in such subsection in cash or in

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

21 services; and

22 ‘‘(2) the Secretary may not, in making a deter23 mination of the amount of non-Federal contribu24 tions, include amounts provided by the Federal Gov-
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1 ernment or services assisted or subsidized by a sig2 nificant extent by the Federal Government.

3 ‘‘SEC. 2823. APPLICATION REQUIREMENTS.

4 ‘‘(a) REQUIREMENT OF APPLICATION.—The Sec5 retary may not award a grant to a State under section

6 2821(b) unless an application for the grant is submitted

7 by the State to the Secretary.

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

9 Secretary shall provide for an application process and de10 velop guidelines to assist States in submitting an applica11 tion under this section that—

12 ‘‘(1) outlines the stroke care system and ex13 plains how such system will ensure that stroke pa14 tients throughout the State have access to quality

15 care in all phases of stroke, consistent with the

16 standards established by the Secretary under sub17 section (c);

18 ‘‘(2) contains standards and requirements for

19 facilities in the State that provide basic preventive

20 services, advanced preventive services, acute stroke

21 care, post-acute stroke care, and rehabilitation serv22 ices to stroke patients; and

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

24 data reporting and analysis system and for the col-
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1 lection of data from each facility that will provide di2 rect care to stroke patients in the State—

3 ‘‘(A) to identify the number of stroke pa4 tients treated in the State;

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

6 for stroke patients at all phases of stroke for

7 the purpose of evaluating the diagnosis, treat8 ment, and treatment outcome of such stroke

9 patients;

10 ‘‘(C) to identify the total amount of un11 compensated and under-compensated stroke

12 care expenditures for each fiscal year by each

13 stroke care facility in the State;

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

15 stroke patients who receive advanced drug ther16 apy;

17 ‘‘(E) to identify patients transferred within

18 the statewide stroke care system, including rea19 sons for such transfer; and

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

21 practicable with the Paul Coverdell National

22 Acute Stroke Registry and Clearinghouse.

23 ‘‘(b) CERTAIN STANDARDS WITH RESPECT TO

24 STATEWIDE STROKE CARE SYSTEM.—
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1 ‘‘(1) IN GENERAL.—The Secretary may not

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

3 a fiscal year unless the State agrees that, in car4 rying out paragraphs (2) and (3), the State will—

5 ‘‘(A) adopt standards of care for stroke pa6 tients in the acute, post-acute, and rehabilita7 tion phases of stroke; and

8 ‘‘(B) in adopting the standards described

9 in subparagraph (A)—

10 ‘‘(i) consult with medical, surgical,

11 and nursing specialty groups, hospital as12 sociations, voluntary health organizations,

13 State offices of rural health, emergency

14 medical services State and local directors,

15 experts in the use of telecommunications

16 technology to provide stroke care, con17 cerned advocates, and other interested par18 ties;

19 ‘‘(ii) conduct hearings on the proposed

20 standards providing adequate notice to the

21 public concerning such hearing; and

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

23 take into account the national standards of

24 care.
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1 ‘‘(2) QUALITY OF STROKE CARE.—The highest

2 quality of stroke care shall be the primary goal of

3 the State standards adopted under this subsection.

4 ‘‘(3) APPROVAL BY SECRETARY.—The Sec5 retary may not make payments to a State under sec6 tion 2821(a) if the Secretary determines that—

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

8 national standards in adopting standards under

9 this subsection;

10 ‘‘(B) in the case of payments for fiscal

11 year 2004 and subsequent fiscal years, the

12 State has not, in adopting such standards,

13 taken into account the national standards of

14 care and the model system plan developed

15 under subsection (c); or

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

17 year 2004 and subsequent fiscal years, the

18 State has not provided to the Secretary the in19 formation received by the State pursuant to

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

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

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

23 Treatment and Ongoing Prevention Act of 2001, the Sec24 retary shall develop standards of care for stroke patients

25 in all phases of stroke that may be adopted for guidance
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1 by the State and a model plan for the establishment of

2 statewide stroke care systems. Such plan shall—

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

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

5 and plans; and

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

7 urban and rural communities, different regions of

8 the Nation, and States with varying degrees of es9 tablished stroke care infrastructures;

10 ‘‘SEC. 2824. REQUIREMENT OF SUBMISSION OF APPLICA11 TION CONTAINING CERTAIN AGREEMENTS

12 AND ASSURANCES.

13 ‘‘The Secretary may not award grants under section

14 2821(a) to a State for a fiscal year unless—

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

16 payments containing agreements in accordance with

17 this part;

18 ‘‘(2) the agreements are made through certifi19 cation from the chief executive officer of the State;

20 ‘‘(3) with respect to such agreements, the appli21 cation provides assurances of compliance satisfactory

22 to the Secretary;

23 ‘‘(4) the application contains the plan provi24 sions and the information required to be submitted

25 to the Secretary pursuant to section 2823; and
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1 ‘‘(5) the application otherwise is in such form,

2 is made in such manner, and contains such agree3 ments, assurances, and information as the Secretary

4 determines to be necessary to carry out this part.

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

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

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

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

9 involved agrees that the payments will not be expended—

10 ‘‘(1) to make cash payments to intended recipi11 ents of services provided pursuant to such section;

12 ‘‘(2) to satisfy any requirement for the expendi13 ture of non-Federal funds as a condition for the re14 ceipt of Federal funds; or

15 ‘‘(3) to provide financial assistance to any enti16 ty other than a public or nonprofit private entity.

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

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

19 carried out, the Secretary may, with respect to an other20 wise qualified State, waive the restriction established in

21 subsection (a)(3).

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

23 ‘‘(a) REPAYMENT OF PAYMENTS.—

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

25 accordance with subsection (b), require a State to
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1 repay any payments received by the State pursuant

2 to section 2821(a) that the Secretary determines

3 were not expended by the State in accordance with

4 the agreements required to be made by the State as

5 a condition of the receipt of payments under such

6 section.

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

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

9 Secretary may offset the amount of the repayment

10 against any amount due to be paid to the State

11 under section 2821(a).

12 ‘‘(b) OPPORTUNITY FOR A HEARING.—Before requir13 ing repayment of payments under subsection (a)(1), the

14 Secretary shall provide to the State an opportunity for a

15 hearing.

16 ‘‘SEC. 2827. SPECIAL CONSIDERATION.

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

18 shall give special consideration to any State that has sub19 mitted an application for carrying out programs under

20 such a grant—

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

22 ‘‘(A) a substantial rate of disability result23 ing from stroke; or

24 ‘‘(B) a substantial incidence of stroke; or
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1 ‘‘(2) that demonstrates a significant need for

2 assistance in establishing a comprehensive stroke

3 care system.

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

5 SECRETARY OF SUPPLIES AND SERVICES IN

6 LIEU OF GRANT FUNDS.

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

8 without charge to a State receiving payments under sec9 tion 2821(a), provide to the State (or to any public or

10 nonprofit entity designated by the State) technical assist11 ance with respect to the planning, development, and oper12 ation of any program carried out pursuant to section

13 2821(b). The Secretary may provide such technical assist14 ance directly, through contract, or through grants.

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

16 SERVICES IN LIEU OF GRANT FUNDS.—

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

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

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

20 supplies, equipment, and services for the purpose of

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

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

23 or employee of the Department of Health and

24 Human Services.
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1 ‘‘(2) REDUCTION IN PAYMENTS.—With respect

2 to a request described in paragraph (1), the Sec3 retary shall reduce the amount of payments to the

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

5 the costs of detailing personnel and the fair market

6 value of any supplies, equipment, or services pro7 vided by the Secretary. The Secretary shall, for the

8 payment of expenses incurred in complying with

9 such request, expend the amounts withheld.

10 ‘‘SEC. 2829. REPORT BY SECRETARY.

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

12 of the Stroke Treatment and Ongoing Prevention Act of

13 2001, the Secretary shall report to the appropriate com14 mittees of Congress on the activities of the States carried

15 out pursuant to section 2821. Such report shall include

16 an assessment of the extent to which Federal and State

17 efforts to develop stroke care systems, including the estab18 lishment of support networks and the identification of

19 acute, comprehensive, and rehabilitation stroke centers,

20 where applicable, have increased the number of stroke pa21 tients who have received acute stroke consultation or ther22 apy within the appropriate timeframe and reduced the

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

24 any recommendations of the Secretary for appropriate ad-
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1 ministrative and legislative initiatives with respect to

2 stroke care.

3 ‘‘SEC. 2830. FUNDING.

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

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

6 $50,000,000 for fiscal year 2002, $75,000,000 for fiscal

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

8 $100,000,000 for fiscal year 2005, and $125,000,000 for

9 fiscal year 2006.

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

11 A State may use not to exceed 10 percent of amounts re12 ceived under a grant awarded under section 2821(a) for

13 administrative expenses.

14 ‘‘PART D—MISCELLANEOUS PROGRAMS

15 ‘‘SEC. 2831. MEDICAL PROFESSIONAL DEVELOPMENT IN AD16 VANCED STROKE TREATMENT AND PREVEN17 TION.

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

19 to public and non-profit private entities for the develop20 ment and implementation of education programs for ap21 propriate medical personnel including medical students,

22 emergency physicians, primary care providers, neurolo23 gists, neurosurgeons, and physical therapists in the use

24 of newly developed diagnostic approaches, technologies,

25 and therapies for the prevention and treatment of stroke.
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1 ‘‘(b) DISTRIBUTION OF GRANTS.—In awarding

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

3 that such grants are equitably distributed among the geo4 graphical regions of the United States and between urban

5 and rural populations.

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

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

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

9 in such manner, and containing such information as the

10 Secretary may require, including a plan for the rigorous

11 evaluation of activities carried out with amounts received

12 under such a grant.

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

14 entity shall use amounts received under a grant under this

15 section for the continuing education of appropriate med16 ical personnel in the use of newly developed diagnostic ap17 proaches, technologies, and therapies for the prevention

18 and treatment of stroke.

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

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

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

22 2002 through 2006.
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S 1274 RS1S

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

2 B, C, AND D

3 ‘‘SEC. 2841. DEFINITIONS.

4 ‘‘In this title:

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

6 the several States, the District of Columbia, the

7 Commonwealth of Puerto Rico, the Indian tribes,

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

9 Commonwealth of the Northern Mariana Islands.

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

11 care system’ means a statewide system to provide

12 for the diagnosis, prehospital care, hospital definitive

13 care, and rehabilitation of stroke patients.

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

15 ‘brain attack’ in which blood flow to the brain is in16 terrupted or in which a blood vessel or aneurysm in

17 the brain breaks or ruptures.

18 ‘‘SEC. 2842. CONSULTATIONS.

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

20 with medical, surgical, rehabilitation, and nursing spe21 cialty groups, hospital associations, voluntary health orga22 nizations, emergency medical services, State directors, and

23 associations, experts in the use of telecommunication tech24 nology to provide stroke care, national disability and con25 sumer organizations representing individuals with disabil-
29

S 1274 RS1S

1 ities and chronic illnesses, concerned advocates, and other

2 interested parties.’’.
Calendar No. 222

107TH CONGRESS

1ST SESSION S. 1274

[Report No. 107–97]

A BILL

To amend the Public Health Service Act to provide

programs for the prevention, treatment, and rehabilitation of stroke.

NOVEMBER 9, 2001

Reported without amendment