I 

113TH CONGRESS 

2D SESSION H. R. 4251 

To direct the Secretary of Health and Human Services, acting through 

the Director of the Centers for Disease Control and Prevention, to 

establish a surveillance system regarding traumatic brain injury, and 

for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

MARCH 14, 2014 

Mr. PASCRELL (for himself and Mr. ROONEY) introduced the following bill; 

which was referred to the Committee on Energy and Commerce 

A BILL 

To direct the Secretary of Health and Human Services, 

acting through the Director of the Centers for Disease 

Control and Prevention, to establish a surveillance system regarding traumatic brain injury, and for other purposes. 

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 ‘‘National Traumatic 

5 Brain Injury Research and Treatment Improvement Act 

6 of 2014’’. 


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1 SEC. 2. FINDINGS. 

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

3 (1) State data and monitoring systems provide 

4 reliable data on injury causes and risk factors, iden5 tify trends in the incidence of traumatic brain in6 jury, enable the development of cause-specific pre7 vention strategies focused on populations at greatest 

8 risk, and monitor the effectiveness of such strate9 gies. 

10 (2) Since 1995, when the Centers for Disease 

11 Control and Prevention published Guidelines for 

12 Surveillance of Central Nervous System Injury, ad13 ditional causes of traumatic brain injury have 

14 emerged: military-related traumatic brain injuries; 

15 sports-related concussions; traffic injuries resulting 

16 from texting while driving; and increasing numbers 

17 of falls-related traumatic brain injuries among older 

18 adults. 

19 (3) In their 2013 report, Sports-Related Con20 cussions in Youth: Improving the Science, Changing 

21 the Culture, the Institute on Medicine and the Na22 tional Research Council noted that there is currently 

23 a lack of data to accurately estimate the incidence 

24 of sports-related concussions across a variety of 

25 sports and for youth across the pediatric age spec26 trum. The report recommended that the Centers for 


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1 Disease Control and Prevention establish and over2 see a national surveillance system to accurately de3 termine the incidence of sports-related concussions, 

4 including those in youth ages 5 to 21, taking into 

5 account Federal efforts to collect information on 

6 traumatic brain injury. 

7 (4) Traumatic brain injury is a substantial pub8 lic health problem among older persons. As the pop9 ulation of older persons continues to grow in the 

10 United States, the need to design and implement 

11 proven and cost-effective prevention measures that 

12 focus on the leading causes of traumatic brain injury 

13 becomes more urgent. 

14 (5) In order to implement this Act, the Centers 

15 for Disease Control and Prevention needs to collabo16 rate with Federal agencies reporting military-related 

17 traumatic brain injuries, school systems reporting 

18 traumatic brain injuries, Medicaid and other Federal 

19 programs, and State agencies. 

20 SEC. 3. ESTABLISHING REQUIREMENTS TO IMPROVE THE 

21 RESEARCH AND TREATMENT OF TRAUMATIC 

22 BRAIN INJURY. 

23 (a) IN GENERAL.—The Secretary, acting through the 

24 Director of the Centers for Disease Control and Preven25 tion, shall— 


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1 (1) evaluate existing surveillance and data col2 lections systems that track the incidence and cir3 cumstances of traumatic brain injury, including con4 cussion; 

5 (2) not later than 9 months after the date of 

6 enactment of this Act, submit a report to the Con7 gress outlining the findings of the evaluation under 

8 paragraph (1); and 

9 (3) establish a statistically sound, scientifically 

10 credible, integrated surveillance system regarding 

11 traumatic brain injury, to be known as the ‘‘Na12 tional Traumatic Brain Injury Surveillance System’’. 

13 (b) RESEARCH.—The Secretary shall ensure that the 

14 National Traumatic Brain Injury Surveillance System is 

15 designed in a manner that facilitates further research on 

16 brain injury. 

17 (c) CONTENT.—In carrying out subsection (a), the 

18 Secretary— 

19 (1) shall provide for the collection and storage 

20 of information (excluding personally identifiable in21 formation) on the incidence and prevalence of trau22 matic brain injury, including concussion, in the 

23 United States across the lifespan; 

24 (2) to the extent practicable, shall provide for 

25 the collection and storage of other available informaVerDate Mar 15 2010 23:25 Mar 20, 2014 Jkt 039200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H4251.IH H4251

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1 tion (excluding personally identifiable information) 

2 on traumatic brain injury, such as information con3 cerning demographics and other information associ4 ated with the incidence of a traumatic brain injury, 

5 such as— 

6 (A) age; 

7 (B) race and ethnicity; 

8 (C) sex; 

9 (D) geographic location; 

10 (E) history of head injury (including injury 

11 type and the approximate date of injury); 

12 (F) pre-existing conditions, such as learn13 ing disabilities and attention deficit hyper14 activity disorder; and 

15 (G) co-occurring issues, such as substance 

16 abuse or post-traumatic stress disorder; 

17 (3) to the extent practicable, shall provide for 

18 the collection and storage of information relevant to 

19 analysis on traumatic brain injury, such as informa20 tion concerning— 

21 (A) impact location on the body and na22 ture of the impact; 

23 (B) qualifications of personnel making the 

24 traumatic brain injury diagnosis; 


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1 (C) assessment tool used to make the diag2 nosis; 

3 (D) signs and symptoms consistent with a 

4 head injury; 

5 (E) sport or activity and the level of com6 petition (if a sports-related activity); 

7 (F) use of protective equipment and im8 pact monitoring devices; and 

9 (G) severity of the traumatic brain injury; 

10 and 

11 (4) may address issues identified during the 

12 consultation process under subsection (d). 

13 (d) CONSULTATION.—In carrying out this section, 

14 the Secretary shall consult with individuals with appro15 priate expertise, including— 

16 (1) epidemiologists with experience in disease 

17 surveillance or registries; 

18 (2) representatives of national health associa19 tions that— 

20 (A) focus on brain injury; and 

21 (B) have demonstrated experience in re22 search, care, or patient services; 

23 (3) State public health agencies; 

24 (4) health information technology experts or 

25 other information management specialists; 


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1 (5) clinicians with expertise in brain injury; 

2 (6) research scientists with experience con3 ducting brain research or utilizing surveillance sys4 tems for scientific research purposes; 

5 (7) medical facilities of the Department of Vet6 erans Affairs; and 

7 (8) behavioral health centers. 

8 (e) GRANTS.—The Secretary may award grants to, 

9 or enter into contracts or cooperative agreements with, 

10 public or private nonprofit entities to carry out activities 

11 under this section. 

12 (f) COORDINATION WITH OTHER FEDERAL AGEN13 CIES.—Subject to subsection (h), the Secretary shall make 

14 information and analysis in the National Traumatic Brain 

15 Injury Surveillance System available, as appropriate, to 

16 Federal departments and agencies, such as the National 

17 Institutes of Health, the Health Resources and Services 

18 Administration, the Food and Drug Administration, the 

19 Centers for Medicare & Medicaid Services, the Agency for 

20 Healthcare Research and Quality, the Department of Edu21 cation, the Department of Veterans Affairs, and the De22 partment of Defense. 

23 (g) PUBLIC ACCESS.—Subject to subsection (h), the 

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1 tional Traumatic Brain Injury Surveillance System avail2 able, as appropriate, to the public, including researchers. 

3 (h) PRIVACY.—The Secretary shall ensure that pri4 vacy and security protections applicable to the National 

5 Traumatic Brain Injury Surveillance System are at least 

6 as stringent as the privacy and security protections under 

7 HIPAA privacy and security law, including nondisclosure 

8 of personally identifiable information. 

9 (i) REPORT.—Not later than 2 years after the date 

10 of enactment of this Act, the Secretary shall submit a re11 port to the Congress concerning the implementation of 

12 this section. Such report shall include information on— 

13 (1) the development and maintenance of the 

14 National Traumatic Brain Injury Surveillance Sys15 tem; 

16 (2) the type of information collected and stored 

17 in the System; 

18 (3) the use and availability of such information, 

19 including guidelines for such use; and 

20 (4) the use and coordination of databases that 

21 collect or maintain information on traumatic brain 

22 injury. 

23 (j) DEFINITION.—In this Act: 

24 (1) NATIONAL HEALTH ASSOCIATION.—The 

25 term ‘‘national health association’’ means a national 


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1 nonprofit organization with chapters, other affiliated 

2 organizations, or networks in States throughout the 

3 United States. 

4 (2) HIPAA PRIVACY AND SECURITY LAW.—The 

5 term ‘‘HIPAA privacy and security law’’ has the 

6 meaning given to that term in section 3009 of the 

7 Public Health Service Act (42 U.S.C. 300jj–19). 

8 (3) PERSONALLY IDENTIFIABLE INFORMA9 TION.—The term ‘‘personally identifiable informa10 tion’’ means information which can be used to dis11 tinguish or trace an individual’s identity (such as 

12 their name, social security number, or biometric 

13 records) either alone or when combined with other 

14 personal or identifying information which is linked 

15 or linkable to a specific individual (such as date of 

16 birth, place of birth, and mother’s maiden name). 

17 (4) SECRETARY.—The term ‘‘Secretary’’ means 

18 the Secretary of Health and Human Services. 

19 (5) SURVEILLANCE.—The term ‘‘surveillance’’ 

20 means the ongoing, systematic collection, analysis, 

21 interpretation, and dissemination of data (other than 

22 personally identifiable information) regarding a 

23 health-related event for use in public health action 

24 to reduce morbidity and mortality and to improve 

25 health. 


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1 (6) TRAUMATIC BRAIN INJURY.—The term 

2 ‘‘traumatic brain injury’’ means an injury to the 

3 head arising from blunt or penetrating trauma or 

4 from acceleration or deceleration forces associated 

5 with one or more of the following: decreased level of 

6 consciousness, amnesia, objective neurologic or 

7 neuropsychological abnormalities, skull fractures, di8 agnosed intracranial lesions, or head injury listed as 

9 a cause of death in the death certificate. 

10 (k) AUTHORIZATION OF APPROPRIATIONS.—To carry 

11 out this Act, there are authorized to be appropriated such 

12 sums as may be necessary. 

Æ 


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