69–006 

110TH CONGRESS REPORT " ! HOUSE OF REPRESENTATIVES 2d Session 110–567 

TRAUMATIC BRAIN INJURY ACT OF 2008 

APRIL 8, 2008.—Committed to the Committee of the Whole House on the State of 

the Union and ordered to be printed 

Mr. DINGELL, from the Committee on Energy and Commerce, 

submitted the following 

R E P O R T 

[To accompany H.R. 1418] 

[Including cost estimate of the Congressional Budget Office] 

The Committee on Energy and Commerce, to whom was referred 

the bill (H.R. 1418) to provide for the expansion and improvement 

of traumatic brain injury programs, having considered the same, 

report favorably thereon with an amendment and recommend that 

the bill as amended do pass. 

CONTENTS 

Page 

Amendment .............................................................................................................. 1 

Purpose and Summary ............................................................................................ 4 

Background and Need for Legislation .................................................................... 4 

Hearings ................................................................................................................... 5 

Committee Consideration ........................................................................................ 5 

Committee Votes ...................................................................................................... 5 

Committee Oversight Findings ............................................................................... 5 

Statement of General Performance Goals and Objectives .................................... 5 

New Budget Authority, Entitlement Authority, and Tax Expenditures ............. 5 

Earmarks and Tax and Tariff Benefits .................................................................. 6 

Committee Cost Estimate ....................................................................................... 6 

Congressional Budget Office Estimate ................................................................... 6 

Federal Mandates Statement ................................................................................. 8 

Advisory Committee Statement .............................................................................. 8 

Constitutional Authority Statement ...................................................................... 8 

Applicability to Legislative Branch ........................................................................ 8 

Section-by-Section Analysis of the Legislation ...................................................... 8 

Changes in Existing Law Made by the Bill, as Reported ..................................... 10 

AMENDMENT

The amendment is as follows: 

Strike all after the enacting clause and insert the following: 


bajohnson on PROD1PC77 with REPORTS
2 

SECTION 1. SHORT TITLE. 

This Act may be cited as the ‘‘Traumatic Brain Injury Act of 2008’’. 

SEC. 2. CONFORMING AMENDMENTS RELATING TO RESTRUCTURING. 

Part J of title III of the Public Health Service Act (42 U.S.C. 280b et seq.) is 

amended— (1) by redesignating the section 393B (42 U.S.C. 280b–1c) relating to the use 

of allotments for rape prevention education, as section 393A and moving such 

section so that it follows section 393; 

(2) by redesignating existing section 393A (42 U.S.C. 280b–1b) relating to prevention of traumatic brain injury, as section 393B; and 

(3) by redesignating the section 393B (42 U.S.C. 280b–1d) relating to traumatic brain injury registries, as section 393C. 

SEC. 3. TRAUMATIC BRAIN INJURY PROGRAMS OF THE CENTERS FOR DISEASE CONTROL AND 

PREVENTION. 

(a) PREVENTION OF TRAUMATIC BRAIN INJURY.—Clause (ii) of section 393B(b)(3)(A) 

of the Public Health Service Act, as so redesignated, (42 U.S.C. 280b–1b) is amended by striking ‘‘from hospitals and trauma centers’’ and inserting ‘‘from hospitals 

and emergency departments’’. (b) NATIONAL PROGRAM FOR TRAUMATIC BRAIN INJURY SURVEILLANCE AND REG- ISTRIES.—Section 393C of the Public Health Service Act, as so redesignated, (42 

U.S.C. 280b et seq.) is amended— (1) in the section heading, by inserting ‘‘SURVEILLANCE AND’’ after ‘‘NATIONAL

PROGRAM FOR TRAUMATIC BRAIN INJURY’’; and 

(2) in subsection (a), in the matter preceding paragraph (1), by striking ‘‘may 

make grants’’ and all that follows through ‘‘to collect data concerning—’’ and inserting ‘‘may make grants to States or their designees to develop or operate the 

State’s traumatic brain injury surveillance system or registry to determine the 

incidence and prevalence of traumatic brain injury and related disability, to ensure the uniformity of reporting under such system or registry, to link individuals with traumatic brain injury to services and supports, and to link such individuals with academic institutions to conduct applied research that will support 

the development of such surveillance systems and registries as may be necessary. A surveillance system or registry under this section shall provide for the 

collection of data concerning—’’. (c) REPORT.—Section 393C of the Public Health Service Act (as so redesignated) 

is amended by adding at the end the following: ‘‘(b) Not later than 18 months after the date of enactment of the Traumatic Brain 

Injury Act of 2008, the Secretary, acting through the Director of the Centers for Disease Control and Prevention and the Director of the National Institutes of Health 

and in consultation with the Secretary of Defense and the Secretary of Veterans Affairs, shall submit to the relevant committees of Congress a report that contains the 

findings derived from an evaluation concerning activities and procedures that can 

be implemented by the Centers for Disease Control and Prevention to improve the 

collection and dissemination of compatible epidemiological studies on the incidence 

and prevalence of traumatic brain injury in those with traumatic brain injury who 

were formerly in the military. The report shall include recommendations on the 

manner in which such agencies can further collaborate on the development and improvement of traumatic brain injury diagnostic tools and treatments.’’. 

SEC. 4. STUDY ON TRAUMATIC BRAIN INJURY. 

Part J of title III of the Public Health Service Act (42 U.S.C. 280b et seq.) is 

amended by inserting after section 393C, as so redesignated, the following: 

‘‘SEC. 393C–1. STUDY ON TRAUMATIC BRAIN INJURY. 

‘‘(a) STUDY.—The Secretary, acting through the Director of the Centers for Disease 

Control and Prevention with respect to paragraph (1) and in consultation with the 

Director of the National Institutes of Health and other appropriate entities with respect to paragraphs (2), (3), and (4), may conduct a study with respect to traumatic 

brain injury for the purpose of carrying out the following: 

‘‘(1) In collaboration with appropriate State and local health-related agencies—

‘‘(A) determining the incidence of traumatic brain injury and prevalence 

of traumatic brain injury related disability and the clinical aspects of the 

disability in all age groups and racial and ethnic minority groups in the 

general population of the United States, including institutional settings, 

such as nursing homes, correctional facilities, psychiatric hospitals, child 

care facilities, and residential institutes for people with developmental disabilities; and 

‘‘(B) reporting national trends in traumatic brain injury. 


bajohnson on PROD1PC77 with REPORTS
3 

‘‘(2) Identifying common therapeutic interventions which are used for the rehabilitation of individuals with such injuries, and, subject to the availability of 

information, including an analysis of— ‘‘(A) the effectiveness of each such intervention in improving the functioning, including return to work or school and community participation, of 

individuals with brain injuries; ‘‘(B) the comparative effectiveness of interventions employed in the course 

of rehabilitation of individuals with brain injuries to achieve the same or 

similar clinical outcome; and ‘‘(C) the adequacy of existing measures of outcomes and knowledge of factors influencing differential outcomes. ‘‘(3) Identifying interventions and therapies that can prevent or remediate the 

development of secondary neurologic conditions related to traumatic brain injury. ‘‘(4) Developing practice guidelines for the rehabilitation of traumatic brain 

injury at such time as appropriate scientific research becomes available. ‘‘(b) DATES CERTAIN FOR REPORTS.—If the study is conducted under subsection (a), 

the Secretary shall, not later than 3 years after the date of the enactment of the 

Traumatic Brain Injury Act of 2008, submit to Congress a report describing findings 

made as a result of carrying out such subsection (a). ‘‘(c) DEFINITION.—For purposes of this section, the term ‘traumatic brain injury’ means an acquired injury to the brain. Such term does not include brain dysfunction 

caused by congenital or degenerative disorders, nor birth trauma, but may include 

brain injuries caused by anoxia due to trauma including near drowning. The Secretary may revise the definition of such term as the Secretary determines necessary.’’. 

SEC. 5. TRAUMATIC BRAIN INJURY PROGRAMS OF THE NATIONAL INSTITUTES OF HEALTH. 

Section 1261 of the Public Health Service Act (42 U.S.C. 300d–61) is amended— (1) in subsection (b)(2), by striking ‘‘Labor and Human Resources’’ and inserting ‘‘Health, Education, Labor, and Pensions’’; 

(2) in subparagraph (D) of subsection (d)(4), by striking ‘‘head brain injury’’

and inserting ‘‘brain injury’’; and 

(3) in subsection (i), by inserting ‘‘, and such sums as may be necessary for 

each of the fiscal years 2009 through 2012’’ before the period at the end. 

SEC. 6. TRAUMATIC BRAIN INJURY PROGRAMS OF THE HEALTH RESOURCES AND SERVICES 

ADMINISTRATION. 

(a) STATE GRANTS FOR DEMONSTRATION PROJECTS REGARDING TRAUMATIC BRAIN

INJURY.—Section 1252 of the Public Health Service Act (42 U.S.C. 300d–52) is 

amended—

(1) in subsection (a)—

(A) by striking ‘‘may make grants to States’’ and inserting ‘‘may make 

grants to States and American Indian consortia’’; and 

(B) by striking ‘‘health and other services’’ and inserting ‘‘rehabilitation 

and other services’’; 

(2) in subsection (b)—

(A) in paragraphs (1), (3)(A)(i), (3)(A)(iii), and (3)(A)(iv), by striking the 

term ‘‘State’’ each place such term appears and inserting the term ‘‘State 

or American Indian consortium’’; and 

(B) in paragraph (2), by striking ‘‘recommendations to the State’’ and inserting ‘‘recommendations to the State or American Indian consortium’’; 

(3) in subsection (c)(1), by striking the term ‘‘State’’ each place such term appears and inserting ‘‘State or American Indian consortium’’; 

(4) in subsection (e), by striking ‘‘A State that received’’ and all that follows 

through the period and inserting ‘‘A State or American Indian consortium that 

received a grant under this section prior to the date of the enactment of the 

Traumatic Brain Injury Act of 2008 may complete the activities funded by the 

grant.’’; 

(5) in subsection (f)—

(A) in the subsection heading, by inserting ‘‘AND AMERICAN INDIAN CONSORTIUM’’ after ‘‘STATE’’; 

(B) in paragraph (1) in the matter preceding subparagraph (A), paragraph (1)(E), paragraph (2)(A), paragraph (2)(B), paragraph (3) in the matter preceding subparagraph (A), paragraph (3)(E), and paragraph (3)(F), by 

striking the term ‘‘State’’ each place such term appears and inserting ‘‘State 

or American Indian consortium’’; and 

(C) in clause (ii) of paragraph (1)(A), by striking ‘‘children and other individuals’’ and inserting ‘‘children, youth, and adults’’; 

(6) in subsection (h)—


bajohnson on PROD1PC77 with REPORTS
4 

(A) by striking ‘‘Not later than 2 years after the date of the enactment 

of this section, the Secretary’’ and inserting ‘‘Not less than biennially, the 

Secretary’’; 

(B) by striking ‘‘Commerce of the House of Representatives, and to the 

Committee on Labor and Human Resources’’ and inserting ‘‘Energy and 

Commerce of the House of Representatives, and to the Committee on 

Health, Education, Labor, and Pensions’’; and 

(C) by inserting ‘‘and section 1253’’ after ‘‘programs established under 

this section,’’; 

(7) by amending subsection (i) to read as follows: ‘‘(i) DEFINITIONS.—For purposes of this section: ‘‘(1) The terms ‘American Indian consortium’ and ‘State’ have the meanings 

given to those terms in section 1253. ‘‘(2) The term ‘traumatic brain injury’ means an acquired injury to the brain. 

Such term does not include brain dysfunction caused by congenital or degenerative disorders, nor birth trauma, but may include brain injuries caused by anoxia due to trauma. The Secretary may revise the definition of such term as 

the Secretary determines necessary, after consultation with States and other 

appropriate public or nonprofit private entities.’’; and 

(8) in subsection (j), by inserting ‘‘, and such sums as may be necessary for 

each of the fiscal years 2009 through 2012’’ before the period. 

(b) STATE GRANTS FOR PROTECTION AND ADVOCACY SERVICES.—Section 1253 of the 

Public Health Service Act (42 U.S.C. 300d–53) is amended—

(1) in subsections (d) and (e), by striking the term ‘‘subsection (i)’’ each place 

such term appears and inserting ‘‘subsection (l)’’; 

(2) in subsection (g), by inserting ‘‘each fiscal year not later than October 1,’’

before ‘‘the Administrator shall pay’’; 

(3) by redesignating subsections (i) and (j) as subsections (l) and (m), respectively; 

(4) by inserting after subsection (h) the following: 

‘‘(i) DATA COLLECTION.—The Administrator of the Health Resources and Services 

Administration and the Commissioner of the Administration on Developmental Disabilities shall enter into an agreement to coordinate the collection of data by the 

Administrator and the Commissioner regarding protection and advocacy services. 

‘‘(j) TRAINING AND TECHNICAL ASSISTANCE.—

‘‘(1) GRANTS.—For any fiscal year for which the amount appropriated to carry 

out this section is $6,000,000 or greater, the Administrator shall use 2 percent 

of such amount to make a grant to an eligible national association for providing 

for training and technical assistance to protection and advocacy systems. 

‘‘(2) DEFINITION.—In this subsection, the term ‘eligible national association’

means a national association with demonstrated experience in providing training and technical assistance to protection and advocacy systems. 

‘‘(k) SYSTEM AUTHORITY.—In providing services under this section, a protection 

and advocacy system shall have the same authorities, including access to records, 

as such system would have for purposes of providing services under subtitle C of 

the Developmental Disabilities Assistance and Bill of Rights Act of 2000.’’; and 

(5) in subsection (l) (as redesignated by this subsection) by striking ‘‘2002 

through 2005’’ and inserting ‘‘2009 through 2012’’. 

PURPOSE AND SUMMARY

The purpose of H.R. 1418, the ‘‘Traumatic Brain Injury Act of 

2008’’, is to authorize research and public health activities related 

to trauma and traumatic brain injury. 

BACKGROUND AND NEED FOR LEGISLATION

Traumatic brain injuries (TBIs) are caused by sudden jolts, 

blows, or penetrating head traumas that disrupt brain function. Although a traumatic brain injury can happen to anyone, young children, teenaged boys, elderly persons, and military personnel are especially at risk. 

According to the Centers for Disease Control and Prevention 

(CDC), of the 1.5 million Americans who sustain a TBI each year, 

around 50,000 die and another 80,000 to 90,000 experience longterm or lifelong disabilities as a result. Traumatic brain injuries 


bajohnson on PROD1PC77 with REPORTS
5 

can result in disability and the need for help to perform daily living 

activities. 

TBI is different from other disabilities due to the severity of cognitive loss. Most rehabilitation programs are designed for people 

with physical disabilities, not cognitive disabilities that require 

special accommodations. Finding needed services is typically a 

logistical, financial, and psychological challenge for family members 

and other caregivers, because few coordinated systems of care exist 

for individuals with TBI. 

The passage of the Traumatic Brain Injury Act of 1996 has improved TBI service systems at the State level and has increased 

the overall visibility of TBI. More work, however, needs to be done 

at both the national and State levels to build an effective, durable 

service system that meets the needs of individuals with TBI. 

HEARINGS

There were no hearings held in connection to the bill reported by 

the Committee. 

COMMITTEE CONSIDERATION

Tuesday, March 11, 2008, the Subcommittee on Health met in 

open markup session and favorably forwarded H.R. 1418, amended, 

to the full Committee for consideration, by a voice vote. On Thursday, March 13, 2008, the full Committee met in open markup session and ordered H.R. 1418 favorably reported to the House, as 

amended by the Subcommittee on Health, by a voice vote. No 

amendments were offered during full Committee consideration. 

COMMITTEE VOTES

Clause 3(b) of rule XIII of the Rules of the House of Representatives requires the Committee to list the record votes on the motion 

to report legislation and amendments thereto. There were no 

record votes taken on amendments or in connection with ordering 

H.R. 1418 reported to the House. A motion by Mr. Dingell to order 

H.R. 1418 favorably reported to the House, as amended, was 

agreed to by a voice vote. 

COMMITTEE OVERSIGHT FINDINGS

Regarding clause 3(c)(1) of rule XIII of the Rules of the House 

of Representatives, the oversight findings of the Committee regarding H.R. 1418 are reflected in this report. 

STATEMENT OF GENERAL PERFORMANCE GOALS AND OBJECTIVES

The objective of H.R. 1418 is to expand and improve TBI programs to reduce the incidence of TBI through basic and applied research, public education, injury surveillance, and demonstration 

projects to improve protection and advocacy systems. 

NEW BUDGET AUTHORITY, ENTITLEMENT AUTHORITY, AND TAX

EXPENDITURES

Regarding compliance with clause 3(c)(2) of rule XIII of the Rules 

of the House of Representatives, the Committee finds that H.R. 


bajohnson on PROD1PC77 with REPORTS
6 

1418 would result in no new or increased budget authority, entitlement authority, or tax expenditures or revenues. 

EARMARKS AND TAX AND TARIFF BENEFITS

Regarding compliance with clause 9 of rule XXI of the Rules of 

the House of Representatives, H.R. 1418 does not contain any congressional earmarks, limited tax benefits, or limited tariff benefits 

as defined in clause 9(d), 9(e), or 9(f) of rule XXI. 

COMMITTEE COST ESTIMATE

The Committee adopts as its own the cost estimate on H.R. 1418 

prepared by the Director of the Congressional Budget Office pursuant to section 402 of the Congressional Budget Act of 1974. 

CONGRESSIONAL BUDGET OFFICE ESTIMATE

Pursuant to clause 3(c)(3) of rule XIII of the Rules of the House 

of Representatives, the following is the cost estimate on H.R. 1418 

provided by the Congressional Budget Office pursuant to section 

402 of the Congressional Budget Act of 1974: 

U.S. CONGRESS, 

CONGRESSIONAL BUDGET OFFICE, 

Washington, DC, April 7, 2008. 

Hon. JOHN D. DINGELL, 

Chairman, Committee on Energy and Commerce, 

House of Representatives, Washington, DC. 

DEAR MR. CHAIRMAN: The Congressional Budget Office has prepared the enclosed cost estimate for H.R. 1418, the Traumatic 

Brain Injury Act of 2008. 

If you wish further details on this estimate, we will be pleased 

to provide them. The CBO staff contacts are Sarah Evans, Tim 

Gronniger, and Lara Robillard. 

Sincerely, 

ROBERT A. SUNSHINE

(For Peter R. Orszag, Director). 

H.R. 1418—Traumatic Brain Injury Act of 2008 

Summary: H.R. 1418 would amend the Public Health Services 

Act to authorize research and public health activities related to 

trauma and traumatic brain injury (TBI). CBO estimates that implementing the bill would cost $117 million in 2009 and $1.6 billion 

over the 2009–2013 period, subject to the appropriation of the necessary amounts. Enacting H.R. 1418 would not affect direct spending or federal revenues. 

H.R. 1418 contains no intergovernmental or private-sector mandates as defined in the Unfunded Mandates Reform Act (UMRA); 

any costs to state governments and Indian consortia would result 

from complying with conditions of federal assistance. 

Estimated cost to the Federal Government: The estimated budgetary impact of H.R. 1418 is shown in the following table. The costs 

of this legislation fall within budget function 550 (health). 


bajohnson on PROD1PC77 with REPORTS
7 

By fiscal year, in millions of dollars— 

2008 2009 2010 2011 2012 2013 

SPENDING SUBJECT TO APPROPRIATION 

Spending Under Current Law: 

Budget Authority 1 ........................................................................... 391 0 0 0 0 0 

Estimated Outlays ........................................................................... 402 279 60 9 0 0 

Proposed Changes: 

Estimated Authorization Level 1 ...................................................... 0 398 405 413 423 6 

Estimated Outlays ........................................................................... 0 117 338 398 411 295 

Spending Under H.R. 1418: 

Estimated Authorization Level 1 ...................................................... 391 398 405 413 423 6 

Estimated Outlays ........................................................................... 402 396 399 407 411 295 

1 The 2008 level is the amount appropriated for that year for research and other federal activities related to traumatic brain injury. 

Basis of estimate: H.R. 1418 would authorize funding for research, treatment, surveillance, and education activities related to 

trauma and traumatic brain injury at the National Institutes of 

Health (NIH), the Health Resources and Services Administration 

(HRSA), and the Centers for Disease Control and Prevention 

(CDC). CBO estimates that those activities would require the appropriation of $398 million in 2009 and $1.6 billion over the 2009–

2013 period. Assuming the appropriation of necessary amounts, 

CBO estimates that implementing H.R. 1418 would cost $117 million in 2009 and $1.6 billion over the 2009–2013 period. 

The NIH estimates that it will allocate $376 million for traumarelated activities in fiscal year 2008. H.R. 1418 would authorize the 

appropriation of such sums as are necessary for those activities 

over the 2009–2012 period. Based on historical program expenditures at NIH and adjusting for inflation, CBO estimates that NIH 

would require the appropriation of $383 million for 2009 and $1.6 

billion over the 2009–2013 period to conduct the specified activities. 

Implementing those programs would cost $111 million in 2009 and 

$1.5 billion over the 2009–2013 period, assuming appropriation of 

the necessary amounts. 

HRSA allocated $9 million in 2008 for grants to states to expand 

access to care and protection services for TBI. H.R. 1418 would authorize the appropriation of such sums as are necessary for those 

activities over the 2009–2012 period, and would expand the program to allow consortia of American Indians to receive such grants. 

Based on historical spending of those programs, CBO estimates 

that the agency would require the appropriation of $9 million in 

2009 and $37 million over the 2009–2012 period to carry out activities specified by the bill. CBO estimates that implementing those 

provisions of H.R. 1418 would cost $3 million in 2009 and $24 million over the 2009–2013 period, assuming that the necessary 

amounts are appropriated and that future rates of spending resemble historical patterns for similar activities. 

In 2008, the Centers for Disease Control and Prevention allocated $6 million for TBI-related activities, including grants to 

states’ TBI surveillance programs and educational activities. H.R. 

1418 would authorize the appropriation of necessary amounts for 

those and other TBI-related activities, which CBO estimates would 

require $6 million in 2009 and $30 million over the 2009–2013 period. Based on historical spending patterns for those activities, and 

assuming appropriation of the necessary amounts, CBO estimates 


bajohnson on PROD1PC77 with REPORTS
8 

that implementing H.R. 1418’s CDC provisions would cost $3 mil- lion in 2009 and $26 million over the 2009–2013 period. 

Intergovernmental and private-sector impact: H.R. 1418 contains 

no intergovernmental or private-sector mandates as defined in 

UMRA. State governments and Indian consortia would benefit from 

grant funding authorized by the bill. Any costs incurred by those 

entities to qualify for such grants would be incurred voluntarily as 

conditions of federal assistance. 

Previous CBO estimates: On July 23, 2007, CBO transmitted a 

cost estimate for S. 793, the Traumatic Brain Injury Reauthorization Act of 2007, as ordered reported by the Senate Committee on 

Health, Education, Labor, and Pensions on June 27, 2007. The two 

bills are very similar, except that S. 793 would authorize appropriations for the activities administered by HRSA and NIH for the 

2008–2011 period (rather than the 2009–2012 period specified in 

H.R. 1418). CBO’s estimate for H.R. 1418 differs from that for S. 

793 because the authorized periods differ, and because the estimate 

for H.R. 1418 takes into account funding appropriated for fiscal 

year 2008 for TBI-related activities. 

Estimate prepared by: Federal Costs: Sarah Evans, Tim 

Gronniger, and Lara Robillard. Impact on State, Local, and Tribal 

Governments: Lisa Ramirez-Branum. Impact on the Private Sector: 

Patrick Bernhardt. 

Estimate approved by: Keith J. Fontenot, Deputy Assistant Director for Health and Human Resources, Budget Analysis Division. 

FEDERAL MANDATES STATEMENT

The Committee adopts as its own the estimate of Federal mandates regarding H.R. 1418 prepared by the Director of the Congressional Budget Office pursuant to section 423 of the Unfunded Mandates Reform Act. 

ADVISORY COMMITTEE STATEMENT

No advisory committees within the meaning of section 5(b) of the 

Federal Advisory Committee Act would be created by H.R. 1418. 

CONSTITUTIONAL AUTHORITY STATEMENT

Pursuant to clause 3(d)(1) of rule XIII of the Rules of the House 

of Representatives, the Committee finds that the Constitutional authority for H.R. 1418 is provided in the provisions of Article I, section 8, clause 1, that relate to expending funds to provide for the 

general welfare of the United States. 

APPLICABILITY TO LEGISLATIVE BRANCH

The Committee finds that H.R. 1418 does not relate to the terms 

and conditions of employment or access to public services or accommodations within the meaning of section 102(b)(3) of the Congressional Accountability Act of 1995. 

SECTION-BY-SECTION ANALYSIS OF THE LEGISLATION

Section 1. Short title 

Section 1 specifies the short title of the legislation as the ‘‘Reauthorization of the Traumatic Brain Injury Act’’. 


bajohnson on PROD1PC77 with REPORTS
9 

Section 2. Conforming amendments relating to restructuring 

Section 2 re-designates section 393B as section 393A, section 

393A as section 393B, and section 393B as section 393C, so that 

sections pertaining to TBI follow and are not interrupted by the 

other provisions of the Public Health Service Act (PHSA). 

Section 3. Traumatic brain injury programs of the Centers for Disease Control and Prevention 

Section 3 amends part J of Title III of the PHSA as re-designated 

(42 U.S.C. 280b–1b) authorize the dissemination of information related to TBI and its secondary conditions upon an individual’s discharge from hospitals and emergency centers. 

Section 393C of the PHSA, as re-designated (42 U.S.C. 280B et 

seq.), is amended to change the section heading to the ‘National 

Program for Brain Injury Surveillance and Registries.’ This section 

authorizes grants to States or their designees to develop or operate 

the State’s TBI-surveillance system or registry to determine the incidence and prevalence of TBI. The Secretary of the Department of 

Health and Human Services (Secretary) is authorized to ensure the 

uniformity of reporting information. It also ensures that individuals with a TBI are linked with academic institutions to conduct 

applied research that will support the development of such surveillance systems and registries as necessary. 

This section directs the Secretary, acting through the CDC and 

the National Institutes of Health (NIH), in consultation with the 

Department of Defense and Department of Veterans Affairs, to 

study and report on methods of improving data collection and collaboration between civilian and military registries, to include the 

development of diagnostic tools and treatments for traumatic brain 

injuries, within 18 months of enactment of the Act. It is not the 

intent of the legislation to in any way inhibit or supplant the ongoing efforts at the Departments of Veterans Affairs and Defense in 

the research, prevention, and treatment of Traumatic Brain Injury. 

This legislation would supplement and compliment the Federal efforts already underway to address TBI in our Nation’s veterans 

and service members. 

Section 4. Study of traumatic brain injury 

Section 4 authorizes the CDC to conduct a study in consultation 

with NIH to examine aspects of TBI, including determining the incidence and prevalence of TBI in all age groups; collecting, maintaining, and reporting national trends; identifying interventions 

used and that can be used for rehabilitation and their effectiveness; 

analyzing the adequacy of existing measures of outcomes and 

knowledge of factors influencing differential outcomes; and developing guidelines for patient rehabilitation after TBI. 

The report shall be submitted to Congress no later than 3 years 

after the date of enactment. 

Section 5. Traumatic brain injury programs of the National Institutes of Health 

Section 5 reauthorizes the current grant program for the conduct 

of basic and clinical research on trauma, including diagnosis treatment rehabilitation, and general management of trauma and TBI. 


bajohnson on PROD1PC77 with REPORTS
10 

This section authorizes such sums as may be necessary for each 

of the fiscal years 2008 through 2011. 

Section 6. Traumatic brain injury programs of the Health Resources 

and Services Administration 

Section 6 reauthorizes the Secretary to award grants to States, 

and authorizes the Secretary to award grants to the American Indian consortium, for the purpose of carrying out projects to improve 

access to health and other services regarding TBI. 

This section authorizes the Secretary to submit to the committees of jurisdiction no less than biennially, a report describing the 

findings, and results of the programs established under this section. 

Definitions in this section include ‘‘American Indian consortium’’

and ‘‘traumatic brain injury’’. 

Grants are authorized for such sums as may be necessary for 

each of the fiscal years 2008 through 2011. 

This section authorizes the Secretary to award grants to protection and advocacy systems for the purpose of enabling such systems to provide services to individuals with TBI and it directs 

those grants to be awarded directly to any protection and advocacy 

system that complies with the provisions of this section, no later 

than October 1 each fiscal year. 

This section requires the Administrator of the Health Resources 

and Services Administration and the Commissioner of the Administration of Developmental Disabilities to enter into an agreement to 

coordinate the collection of data by the Administrator and the Commissioner regarding protection and advocacy services. 

This section requires for any fiscal year for which the amount appropriated is $6 million or greater, the Administrator to use 2 percent of such amount to make a grant to an eligible national association for providing training and technical assistance for protection and advocacy systems. 

In this section, eligible national association means a national association with demonstrated experience in providing training and 

technical assistance to protection and advocacy systems. 

This section clarifies that protection and advocacy systems are 

allowed the same authorities as such a system would for the purpose of providing services under subtitle C of the Developmental 

Disabilities Assistance and Bill of Rights Act of 2000, including the 

authority to pursue legal, administrative, and other appropriate 

remedies or approaches to ensure that protection of, and advocacy 

for, the rights of such individuals with a TBI and the authority to 

provide information and referral programs and services that address the needs of individuals with traumatic brain injury. 

CHANGES IN EXISTING LAW MADE BY THE BILL, AS REPORTED

In compliance with clause 3(e) of rule XIII of the Rules of the 

House of Representatives, changes in existing law made by the bill, 

as reported, are shown as follows (existing law proposed to be omitted is enclosed in black brackets, new matter is printed in italic, 

existing law in which no change is proposed is shown in roman): 


bajohnson on PROD1PC77 with REPORTS
11 

PUBLIC HEALTH SERVICE ACT 

* * * * * * * 

TITLE III—GENERAL POWERS AND DUTIES OF PUBLIC 

HEALTH SERVICE 

* * * * * * * 

PART J—PREVENTION AND CONTROL OF INJURIES

* * * * * * * 

SEC. ø393B.¿ 393A. USE OF ALLOTMENTS FOR RAPE PREVENTION EDUCATION. 

(a) * * * 

* * * * * * * 

PREVENTION OF TRAUMATIC BRAIN INJURY

SEC. ø393A.¿ 393B. (a) * * * 

(b) CERTAIN ACTIVITIES.—Activities under subsection (a) may include—

(1) * * * 

* * * * * * * 

(3) the implementation of a national education and awareness campaign regarding such injury (in conjunction with the 

program of the Secretary regarding health-status goals for 

2010, commonly referred to as Healthy People 2010), including— (A) the national dissemination of information on— (i) * * * 

(ii) information relating to traumatic brain injury 

and the sequelae of secondary conditions arising from 

traumatic brain injury upon discharge øfrom hospitals 

and trauma centers¿ from hospitals and emergency departments; and 

* * * * * * * 

NATIONAL PROGRAM FOR TRAUMATIC BRAIN INJURY SURVEILLANCE

AND REGISTRIES

SEC. ø393B.¿ 393C. (a) IN GENERAL.—The Secretary, acting 

through the Director of the Centers for Disease Control and Prevention, ømay make grants to States or their designees to operate 

the State’s traumatic brain injury registry, and to academic institutions to conduct applied research that will support the development 

of such registries, to collect data concerning—¿ may make grants 

to States or their designees to develop or operate the State’s traumatic brain injury surveillance system or registry to determine the 

incidence and prevalence of traumatic brain injury and related disability, to ensure the uniformity of reporting under such system or 

registry, to link individuals with traumatic brain injury to services 

and supports, and to link such individuals with academic institutions to conduct applied research that will support the development 

of such surveillance systems and registries as may be necessary. A 

surveillance system or registry under this section shall provide for 

the collection of data concerning—


bajohnson on PROD1PC77 with REPORTS
12 

(1) * * * 

* * * * * * * 

(b) Not later than 18 months after the date of enactment of the 

Traumatic Brain Injury Act of 2008, the Secretary, acting through 

the Director of the Centers for Disease Control and Prevention and 

the Director of the National Institutes of Health and in consultation 

with the Secretary of Defense and the Secretary of Veterans Affairs, 

shall submit to the relevant committees of Congress a report that 

contains the findings derived from an evaluation concerning activities and procedures that can be implemented by the Centers for Disease Control and Prevention to improve the collection and dissemination of compatible epidemiological studies on the incidence and 

prevalence of traumatic brain injury in those with traumatic brain 

injury who were formerly in the military. The report shall include 

recommendations on the manner in which such agencies can further 

collaborate on the development and improvement of traumatic brain 

injury diagnostic tools and treatments. 

SEC. 393C–1. STUDY ON TRAUMATIC BRAIN INJURY. 

(a) STUDY.—The Secretary, acting through the Director of the 

Centers for Disease Control and Prevention with respect to paragraph (1) and in consultation with the Director of the National Institutes of Health and other appropriate entities with respect to 

paragraphs (2), (3), and (4), may conduct a study with respect to 

traumatic brain injury for the purpose of carrying out the following: 

(1) In collaboration with appropriate State and local healthrelated agencies—

(A) determining the incidence of traumatic brain injury 

and prevalence of traumatic brain injury related disability 

and the clinical aspects of the disability in all age groups 

and racial and ethnic minority groups in the general population of the United States, including institutional settings, 

such as nursing homes, correctional facilities, psychiatric 

hospitals, child care facilities, and residential institutes for 

people with developmental disabilities; and 

(B) reporting national trends in traumatic brain injury. 

(2) Identifying common therapeutic interventions which are 

used for the rehabilitation of individuals with such injuries, 

and, subject to the availability of information, including an 

analysis of—

(A) the effectiveness of each such intervention in improving the functioning, including return to work or school and 

community participation, of individuals with brain injuries; 

(B) the comparative effectiveness of interventions employed in the course of rehabilitation of individuals with 

brain injuries to achieve the same or similar clinical outcome; and 

(C) the adequacy of existing measures of outcomes and 

knowledge of factors influencing differential outcomes. 

(3) Identifying interventions and therapies that can prevent or 

remediate the development of secondary neurologic conditions 

related to traumatic brain injury. 


bajohnson on PROD1PC77 with REPORTS
13 

(4) Developing practice guidelines for the rehabilitation of 

traumatic brain injury at such time as appropriate scientific research becomes available. 

(b) DATES CERTAIN FOR REPORTS.—If the study is conducted 

under subsection (a), the Secretary shall, not later than 3 years after 

the date of the enactment of the Traumatic Brain Injury Act of 

2008, submit to Congress a report describing findings made as a result of carrying out such subsection (a). 

(c) DEFINITION.—For purposes of this section, the term ‘‘traumatic 

brain injury’’ means an acquired injury to the brain. Such term 

does not include brain dysfunction caused by congenital or degenerative disorders, nor birth trauma, but may include brain injuries 

caused by anoxia due to trauma including near drowning. The Secretary may revise the definition of such term as the Secretary determines necessary. 

* * * * * * * 

TITLE XII—TRAUMA CARE 

* * * * * * * 

Part E—Miscellaneous Programs 

* * * * * * * 

SEC. 1252. STATE GRANTS FOR PROJECTS REGARDING TRAUMATIC 

BRAIN INJURY. 

(a) IN GENERAL.—The Secretary, acting through the Administrator of the Health Resources and Services Administration, ømay 

make grants to States¿ may make grants to States and American 

Indian consortia for the purpose of carrying out projects to improve 

access to øhealth and other services¿ rehabilitation and other services regarding traumatic brain injury. 

(b) STATE ADVISORY BOARD.—

(1) IN GENERAL.—The Secretary may make a grant under 

subsection (a) only if the øState¿ State or American Indian 

consortium involved agrees to establish an advisory board 

within the appropriate health department of the øState¿ State 

or American Indian consortium or within another department 

as designated by the chief executive officer of the øState¿ State 

or American Indian consortium. 

(2) FUNCTIONS.—An advisory board established under paragraph (1) shall advise and make ørecommendations to the 

State¿ recommendations to the State or American Indian consortium on ways to improve services coordination regarding 

traumatic brain injury. Such advisory boards shall encourage 

citizen participation through the establishment of public hearings and other types of community outreach programs. In developing recommendations under this paragraph, such boards 

shall consult with Federal, State, and local governmental agencies and with citizens groups and other private entities. 

(3) COMPOSITION.—An advisory board established under 

paragraph (1) shall be composed of—

(A) representatives of—


bajohnson on PROD1PC77 with REPORTS
14 

(i) the corresponding øState¿ State or American Indian consortium agencies involved; 

* * * * * * * 

(iii) other disability advisory or planning groups 

within the øState¿ State or American Indian consortium; 

(iv) members of an organization or foundation representing individuals with traumatic brain injury in 

that øState¿ State or American Indian consortium; 

and 

* * * * * * * 

(c) MATCHING FUNDS.— (1) IN GENERAL.—With respect to the costs to be incurred by 

a øState¿ State or American Indian consortium in carrying out 

the purpose described in subsection (a), the Secretary may 

make a grant under such subsection only if the øState¿ State 

or American Indian consortium agrees to make available nonFederal contributions toward such costs in an amount that is 

not less than $1 for each $2 of Federal funds provided under 

the grant. 

* * * * * * * 

(e) CONTINUATION OF PREVIOUSLY AWARDED DEMONSTRATION

PROJECTS.—øA State that received a grant under this section prior 

to the date of the enactment of the Children’s Health Act of 2000 

may compete for new project grants under this section after such 

date of the enactment.¿ A State or American Indian consortium 

that received a grant under this section prior to the date of the enactment of the Traumatic Brain Injury Act of 2008 may complete 

the activities funded by the grant. 

(f) USE OF STATE AND AMERICAN INDIAN CONSORTIUM GRANTS.— (1) COMMUNITY SERVICES AND SUPPORTS.—A øState¿ State or 

American Indian consortium shall (directly or through awards 

of contracts to nonprofit private entities) use amounts received 

under a grant under this section for the following: 

(A) To develop, change, or enhance community-based 

service delivery systems that include timely access to comprehensive appropriate services and supports. Such service 

and supports—

(i) * * * 

(ii) shall be designed for øchildren and other individuals¿ children, youth, and adults with traumatic brain 

injury. 

* * * * * * * 

(E) To support other needs identified by the advisory 

board under subsection (b) for the øState¿ State or American Indian consortium involved. 

(2) BEST PRACTICES.—

(A) IN GENERAL.—øState¿ State or American Indian consortium services and supports provided under a grant 

under this section shall reflect the best practices in the 

field of traumatic brain injury, shall be in compliance with 

title II of the Americans with Disabilities Act of 1990, and 

shall be supported by quality assurance measures as well 


bajohnson on PROD1PC77 with REPORTS
15 

as state-of-the-art health care and integrated community 

supports, regardless of the severity of injury. 

(B) DEMONSTRATION BY STATE AGENCY.—The øState¿ 

State or American Indian consortium agency responsible 

for administering amounts received under a grant under 

this section shall demonstrate that it has obtained knowledge and expertise of traumatic brain injury and the 

unique needs associated with traumatic brain injury. 

(3) STATE CAPACITY BUILDING.—A øState¿ State or American 

Indian consortium may use amounts received under a grant 

under this section to— (A) * * * 

* * * * * * * 

(E) tailor existing øState¿ State or American Indian consortium systems to provide accommodations to the needs of 

individuals with brain injury (including systems administered by the øState¿ State or American Indian consortium 

departments responsible for health, mental health, labor/ 

employment, education, mental retardation /developmental 

disorders, transportation, and correctional systems); 

(F) improve data sets coordinated across systems and 

other needs identified by a øState¿ State or American Indian consortium plan supported by its advisory council; 

and 

* * * * * * * 

(h) REPORT.—øNot later than 2 years after the date of the enactment of this section, the Secretary¿ Not less than biennially, the 

Secretary shall submit to the Committee on øCommerce of the 

House of Representatives, and to the Committee on Labor and 

Human Resources¿ Energy and Commerce of the House of Representatives, and to the Committee on Health, Education, Labor, 

and Pensions of the Senate, a report describing the findings and results of the programs established under this section, and section 

1253 including measures of outcomes and consumer and surrogate 

satisfaction. 

ø(i) DEFINITION.—For purposes of this section, the term ‘‘traumatic brain injury’’ means an acquired injury to the brain. Such 

term does not include brain dysfunction caused by congenital or degenerative disorders, nor birth trauma, but may include brain injuries caused by anoxia due to trauma. The Secretary may revise the 

definition of such term as the Secretary determines necessary, after 

consultation with States and other appropriate public or nonprofit 

private entities.¿ 

(i) DEFINITIONS.—For purposes of this section: 

(1) The terms ‘‘American Indian consortium’’ and ‘‘State’’

have the meanings given to those terms in section 1253. 

(2) The term ‘‘traumatic brain injury’’ means an acquired injury to the brain. Such term does not include brain dysfunction 

caused by congenital or degenerative disorders, nor birth trauma, but may include brain injuries caused by anoxia due to 

trauma. The Secretary may revise the definition of such term as 

the Secretary determines necessary, after consultation with 

States and other appropriate public or nonprofit private entities. 


bajohnson on PROD1PC77 with REPORTS
16 

(j) AUTHORIZATION OF APPROPRIATIONS.—For the purpose of carrying out this section, there are authorized to be appropriated such 

sums as may be necessary for each of the fiscal years 2001 through 

2005, and such sums as may be necessary for each of the fiscal 

years 2009 through 2012. 

SEC. 1253. STATE GRANTS FOR PROTECTION AND ADVOCACY SERVICES. 

(a) * * * 

* * * * * * * 

(d) APPROPRIATIONS LESS THAN $2,700,000.— (1) IN GENERAL.—With respect to any fiscal year in which 

the amount appropriated under øsubsection (i)¿ subsection (l) 

to carry out this section is less than $2,700,000, the Administrator shall make grants from such amount to individual protection and advocacy systems within States to enable such systems to plan for, develop outreach strategies for, and carry out 

services authorized under this section for individuals with 

traumatic brain injury. 

* * * * * * * 

(e) APPROPRIATIONS OF $2,700,000 OR MORE.—

(1) POPULATION BASIS.—Except as provided in paragraph (2), 

with respect to each fiscal year in which the amount appropriated under øsubsection (i)¿ subsection (l) to carry out this 

section is $2,700,000 or more, the Administrator shall make a 

grant to a protection and advocacy system within each State. 

(2) AMOUNT.—The amount of a grant provided to a system 

under paragraph (1) shall be equal to an amount bearing the 

same ratio to the total amount appropriated for the fiscal year 

involved under øsubsection (i)¿ subsection (l) as the population 

of the State in which the grantee is located bears to the population of all States. 

* * * * * * * 

(4) INFLATION ADJUSTMENT.—For each fiscal year in which 

the total amount appropriated under øsubsection (i)¿ subsection (l) to carry out this section is $5,000,000 or more, and 

such appropriated amount exceeds the total amount appropriated to carry out this section in the preceding fiscal year, 

the Administrator shall increase each of the minimum grants 

amount described in subparagraphs (A) and (B) of paragraph 

(3) by a percentage equal to the percentage increase in the 

total amount appropriated under øsubsection (i)¿ subsection (l) 

to carry out this section between the preceding fiscal year and 

the fiscal year involved. 

* * * * * * * 

(g) DIRECT PAYMENT.—Notwithstanding any other provision of 

law, each fiscal year not later than October 1, the Administrator 

shall pay directly to any protection and advocacy system that complies with the provisions of this section, the total amount of the 

grant for such system, unless the system provides otherwise for 

such payment. 

* * * * * * * 


bajohnson on PROD1PC77 with REPORTS
17 

(i) DATA COLLECTION.—The Administrator of the Health Resources and Services Administration and the Commissioner of the 

Administration on Developmental Disabilities shall enter into an 

agreement to coordinate the collection of data by the Administrator 

and the Commissioner regarding protection and advocacy services. 

(j) TRAINING AND TECHNICAL ASSISTANCE.—

(1) GRANTS.—For any fiscal year for which the amount appropriated to carry out this section is $6,000,000 or greater, the 

Administrator shall use 2 percent of such amount to make a 

grant to an eligible national association for providing for training and technical assistance to protection and advocacy systems. 

(2) DEFINITION.—In this subsection, the term ‘‘eligible national association’’ means a national association with demonstrated experience in providing training and technical assistance to protection and advocacy systems. 

(k) SYSTEM AUTHORITY.—In providing services under this section, 

a protection and advocacy system shall have the same authorities, 

including access to records, as such system would have for purposes 

of providing services under subtitle C of the Developmental Disabilities Assistance and Bill of Rights Act of 2000. 

ø(i)¿ (l) AUTHORIZATION OF APPROPRIATIONS.—There are authorized to be appropriated to carry out this section $5,000,000 for fiscal year 2001, and such sums as may be necessary for each the fiscal years ø2002 through 2005¿ 2009 through 2012. 

ø(j)¿ (m) DEFINITIONS.—In this section: 

(1) * * * 

* * * * * * * 

PART F—INTERAGENCY PROGRAM FOR TRAUMA RESEARCH

SEC. 1261. ESTABLISHMENT OF PROGRAM. 

(a) * * * 

(b) PLAN FOR PROGRAM.—

(1) * * * 

(2) SUBMISSION TO CONGRESS.—Not later than December 1, 

1993, the Director shall submit the plan required in paragraph 

(1) to the Committee on Energy and Commerce of the House 

of Representatives, and to the Committee on øLabor and 

Human Resources¿ Health, Education, Labor, and Pensions of 

the Senate, together with an estimate of the funds needed for 

each of the fiscal years 1994 through 1996 to implement the 

plan. 

* * * * * * * 

(d) CERTAIN ACTIVITIES OF PROGRAM.—The Program shall include—

(1) * * * 

* * * * * * * 

(4) the authority to make awards of grants or contracts to 

public or nonprofit private entities for the conduct of basic and 

applied research regarding traumatic brain injury, which research may include—


bajohnson on PROD1PC77 with REPORTS
18 

(A) * * * 

* * * * * * * 

(D) the development of programs that increase the participation of academic centers of excellence in øhead brain 

injury¿ brain injury treatment and rehabilitation research 

and training; and 

* * * * * * * 

(i) AUTHORIZATION OF APPROPRIATIONS.—For the purpose of carrying out this section, there are authorized to be appropriated such 

sums as may be necessary for each of the fiscal years 2001 through 

2005, and such sums as may be necessary for each of the fiscal 

years 2009 through 2012. 

* * * * * * * 

Æ 


bajohnson on PROD1PC77 with REPORTS