I

103D CONGRESS

1ST SESSION H. R. 2427

To amend title XIX of the Social Security Act to provide for optional coverage

under State medicaid plans of case-management services for individuals

who sustain traumatic brain injuries, and for other purposes.

IN THE HOUSE OF REPRESENTATIVES

JUNE 15, 1993

Mr. WYDEN (for himself, Mrs. UNSOELD, and Mr. FRANK of Massachusetts)

introduced the following bill; which was referred to the Committee on

Energy and Commerce

A BILL

To amend title XIX of the Social Security Act to provide

for optional coverage under State medicaid plans of casemanagement services for individuals who sustain traumatic brain injuries, 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 ‘‘Medicaid Brain Injury

5 Rehabilitation Act of 1993’’.
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1 SEC. 2. MEDICAID COVERAGE OF CASE-MANAGEMENT

2 SERVICES FOR INDIVIDUALS WITH TRAU3 MATIC BRAIN INJURIES.

4 (a) IN GENERAL.—Section 1905(a) of the Social Se5 curity Act (42 U.S.C. 1396d(a)) is amended—

6 (1) by striking ‘‘and’’ at the end of paragraph

7 (21);

8 (2) by striking the period at the end of para9 graph (24) and inserting a semicolon;

10 (3) by redesignating paragraphs (22), (23), and

11 (24) as paragraphs (25), (22), and (23), respec12 tively, and by transferring and inserting paragraph

13 (25) after paragraph (23), as so redesignated; and

14 (4) by inserting after paragraph (23), as redes15 ignated, the following new paragraph:

16 ‘‘(24) case-management services provided (in

17 accordance with section 1931) for individuals who

18 sustain traumatic brain injuries; and’’.

19 (b) CASE-MANAGEMENT SERVICES DESCRIBED.—

20 Title XIX of the Social Security Act (42 U.S.C. 1396 et

21 seq.) is amended by adding at the end the following new

22 section:

23 ‘‘CASE-MANAGEMENT SERVICES FOR INDIVIDUALS WITH

24 TRAUMATIC BRAIN INJURIES

25 ‘‘SEC. 1931. (a) IN GENERAL.—For purposes of sec26 tion 1905(a)(24), case-management services for individ-
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1 uals who sustain traumatic brain injuries are services pro2 vided to an eligible individual (as described in subsection

3 (d)) through a State case-management program that

4 meets the requirements of subsection (b).

5 ‘‘(b) REQUIREMENTS FOR STATE CASE-MANAGE6 MENT PROGRAMS.—

7 ‘‘(1) STATE COORDINATOR.—A State case-man8 agement program meets the requirements of this

9 subsection only if the State has designated a State

10 coordinator (in this section referred to as the ‘State

11 coordinator’) for traumatic brain injuries who—

12 ‘‘(A) establishes policies, standards, and

13 procedures for providing services under this sec14 tion to eligible individuals,

15 ‘‘(B) contracts with qualified agencies or

16 employs staff to provide services under this sec17 tion to eligible individuals,

18 ‘‘(C) supervises and coordinates services

19 for eligible individuals,

20 ‘‘(D) makes necessary reports to the Sec21 retary, and

22 ‘‘(E) performs any other duties described

23 in this section.

24 ‘‘(2) CASE-MANAGEMENT SERVICES.—A State

25 case-management program meets the requirements
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1 of this subsection only if the program provides or ar2 ranges for the provision of the following case-man3 agement services for eligible individuals:

4 ‘‘(A) An initial assessment of—

5 ‘‘(i) the individual’s need for case6 management services, and

7 ‘‘(ii) if the individual is an appro8 priate candidate for receiving case-manage9 ment services, the individual’s need for

10 other services, with an emphasis on identi11 fying community-based services required to

12 prevent institutionalization or minimize the

13 need for residential rehabilitation.

14 ‘‘(B) Preparation of a treatment plan for

15 each individual requiring case-management

16 services based on consultation with the individ17 ual (other than an individual who is comatose)

18 and any person named by the individual. Prepa19 ration of the plan shall be completed—

20 ‘‘(i) as soon as possible after the indi21 vidual suffers the injury, but may be de22 layed (by one or more periods of no more

23 than 15 days each) based on a physician

24 certification that contains a brief expla25 nation of the reason for the delay and at-
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1 tests that such a delay is in the best inter2 ests of the individual, or

3 ‘‘(ii) in the case of an individual who,

4 at the time the individual sustains the

5 traumatic brain injury, is not an eligible

6 individual, within 60 days after such indi7 vidual becomes an eligible individual.

8 ‘‘(C) Presentation of a copy of the initial

9 treatment plan and any subsequent modifica10 tions to the plan to the individual or the indi11 vidual’s legal representative.

12 ‘‘(D) Regular updates of each individual’s

13 treatment plan (based on consultation with the

14 care provider, the individual, and any person

15 named by the individual) with data and infor16 mation about treatments and services provided,

17 as well as specific outcome measures of the in18 dividual’s performance or activity relative to

19 goals previously established.

20 ‘‘(E) Assistance in obtaining services nec21 essary to allow the individual to remain in the

22 community, including coordination of home care

23 services with other services.
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1 ‘‘(F) Advocacy services to assist the indi2 vidual in obtaining appropriate, accessible, and

3 cost-effective services.

4 ‘‘(G) Assessment of the individual’s need

5 for and level of home care services at appro6 priate intervals during the course of the individ7 ual’s treatment under the program.

8 ‘‘(H) Reassessment of each individual at

9 regular intervals of at least every 3 months to

10 determine the extent of each individual’s

11 progress and to ascertain whether the individ12 ual—

13 ‘‘(i) is being kept too long in a given

14 setting,

15 ‘‘(ii) is being provided services inap16 propriately, or

17 ‘‘(iii) would be better served by other

18 services or in another setting.

19 ‘‘(3) COORDINATION AND ADMINISTRATION OF

20 BENEFITS AND SERVICES.—A State case-manage21 ment program meets the requirements of this sub22 section only if the program assists in ensuring that

23 an eligible individual is referred to and applies for

24 other benefits (through cooperative agreements with

25 agencies administering benefit programs) and serv-
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1 ices for which the individual is eligible under other

2 Federal, State, or local programs, including—

3 ‘‘(A) employment services, including voca4 tional assessment, training, and placement,

5 sheltered employment, and supported employ6 ment;

7 ‘‘(B) education benefits, including primary,

8 secondary, and higher education programs;

9 ‘‘(C) services available under the Older

10 Americans Act of 1965;

11 ‘‘(D) disability insurance under title II;

12 and

13 ‘‘(E) independent living services under title

14 VII of the Rehabilitation Act of 1973.

15 ‘‘(4) LICENSURE AND COMPLAINT PROCE16 DURE.—A State case-management program meets

17 the requirements of this subsection only if the pro18 gram provides for the following:

19 ‘‘(A) Assuring that any residential setting

20 or facility which provides services to individuals

21 under the program meets any applicable State

22 or local requirements regarding certification or

23 licensure.

24 ‘‘(B) A complaint procedure, overseen by

25 the State coordinator, regarding any treatment
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1 or service provided to an individual which pro2 vides that—

3 ‘‘(i) the individual or any person

4 named by the individual may make an oral

5 or written complaint;

6 ‘‘(ii) the individual or any person

7 named by the individual may receive the

8 response to the complaint;

9 ‘‘(iii) the confidentiality of any com10 plainant is maintained;

11 ‘‘(iv) an investigation of the complaint

12 is completed within—

13 ‘‘(I) 30 days for a routine com14 plaint,

15 ‘‘(II) 7 days for a complaint of

16 abuse or neglect, and

17 ‘‘(III) 24 hours if the individual’s

18 life or safety is immediately threat19 ened; and

20 ‘‘(v) if the complaint is with respect to

21 a publicly appointed case manager or case

22 worker, substitution of such manager or

23 worker is allowed.

24 ‘‘(5) RIGHTS.—
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1 ‘‘(A) NOTICE.—A State case-management

2 program meets the requirements of this sub3 section only if the State coordinator—

4 ‘‘(i) provides for the distribution of a

5 notice of the rights described in subpara6 graph (B) (including a telephone number

7 to call to register complaints of alleged vio8 lations of such rights) to all case managers

9 and residential facilities which provide

10 services under the program to eligible indi11 viduals; and

12 ‘‘(ii) ensures that such managers and

13 facilities—

14 ‘‘(I) distribute such notice to

15 each eligible individual served under

16 the program, and

17 ‘‘(II) prominently post such a no18 tice in a location readily accessible to

19 such individuals.

20 ‘‘(B) RIGHTS SPECIFIED.—The following

21 are the rights of eligible individuals receiving

22 services under a State case-management pro23 gram that meets the requirements of this sub24 section:
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1 ‘‘(i) FREE CHOICE.—The right to

2 choose a personal attending physician, to

3 be fully informed in advance about care

4 and treatment, to be fully informed in ad5 vance of any changes in care or treatment

6 that may affect the individual’s well-being,

7 and (except with respect to an individual

8 adjudged incompetent) to participate in

9 planning care and treatment or changes in

10 care and treatment.

11 ‘‘(ii) FREE FROM PHYSICAL RE12 STRAINTS.—The right to be free from

13 physical or mental abuse, corporal punish14 ment, involuntary seclusion, and any phys15 ical or chemicals imposed for purposes of

16 discipline or convenience and not required

17 to treat the individual’s medical symptoms.

18 Restraints may only be imposed—

19 ‘‘(I) to ensure the physical safety

20 of the individual or other individuals,

21 and

22 ‘‘(II) only upon the written order

23 of a physician (or other health profes24 sional so authorized under State law)

25 that specifies the duration and cir-
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1 cumstances under which the restraints

2 are to be used (except in emergency

3 circumstances) until such an order

4 could reasonably be obtained.

5 ‘‘(iii) FREE FROM PHARMACOLOGICAL

6 RESTRAINTS.—Psychopharmacologic drugs

7 may be administered only on the orders of

8 a physician (or other health professional

9 authorized to prescribe under State law)

10 and only as part of a plan designed to

11 eliminate or modify the symptoms for

12 which the drugs are prescribed and only if,

13 at least annually, an independent, external

14 consultant reviews the appropriateness of

15 the drug plan of each individual receiving

16 such drugs.

17 ‘‘(iv) PRIVACY.—The right to privacy

18 with regard to accommodations, medical

19 treatment, written and telephonic commu20 nications, visits, and meetings of family

21 and of patient groups.

22 ‘‘(v) CONFIDENTIALITY.—The right to

23 confidentiality of personal and clinical

24 records.
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1 ‘‘(vi) ACCOMMODATION OF NEEDS.—

2 The right—

3 ‘‘(I) to receive services with rea4 sonable accommodation of individual

5 needs and preferences, except where

6 the health or safety of the individual

7 or other individuals would be endan8 gered, and

9 ‘‘(II) in the case of a residential

10 facility, to receive notice before the

11 room or roommate of an individual

12 living in the facility is changed.

13 ‘‘(vii) GRIEVANCES.—The right to

14 voice grievances with respect to treatment

15 of care that is (or fails to be) furnished,

16 without discrimination or reprisal for voic17 ing the grievances, and the right to prompt

18 efforts by the provider to resolve griev19 ances the individual may have, including

20 those with respect to the behavior of other

21 individuals.

22 ‘‘(viii) PARTICIPATION IN PATIENT

23 AND FAMILY GROUPS.—In the case of a

24 residential facility, the right of the individ25 ual to organize and participate in resident
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1 groups and the right of the individual’s

2 family to meet with the families of other

3 patients.

4 ‘‘(ix) PARTICIPATION IN OTHER AC5 TIVITIES.—In the case of a residential fa6 cility, the right of the individual to partici7 pate in social, religious, and community ac8 tivities that do not interfere with the rights

9 of other individuals.

10 ‘‘(x) TRANSFER AND DISCHARGE

11 RIGHTS FOR RESIDENTS OF RESIDENTIAL

12 CARE FACILITIES.—In the case of a resi13 dential facility, the facility must permit

14 each eligible individual who is a resident to

15 remain in the facility and must not trans16 fer or discharge the resident from the facil17 ity unless—

18 ‘‘(I) the transfer or discharge is

19 necessary to meet the resident’s wel20 fare and the resident’s welfare cannot

21 be met in the facility,

22 ‘‘(II) the transfer or discharge is

23 appropriate because the resident has

24 improved sufficiently so the resident
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1 no longer needs the services provided

2 by the facility,

3 ‘‘(III) the safety or health of in4 dividuals in the facility would other5 wise be endangered,

6 ‘‘(IV) the resident has failed,

7 after reasonable and appropriate no8 tice, to pay (or to have paid on the

9 resident’s behalf under this title or

10 under another program for which the

11 resident is eligible to receive benefits)

12 an allowable charge imposed by the

13 facility for an item or service re14 quested by the resident, or

15 ‘‘(V) the facility ceases to oper16 ate.

17 ‘‘(xi) PRE-TRANSFER AND PRE-DIS18 CHARGE NOTICE.—In the case of a resi19 dential facility, before effecting a transfer

20 or discharge of an eligible individual who is

21 a resident, the facility must—

22 ‘‘(I) notify the resident (and, if

23 known, a family member of a resident

24 or legal representative) of the transfer
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1 or discharge and the reasons there2 fore, and

3 ‘‘(II) record the reasons in the

4 resident’s plan of care.

5 ‘‘(C) RIGHTS OF INCOMPETENT INDIVID6 UALS.—In the case of an individual adjudged

7 incompetent under the laws of a State, the

8 rights of the individual under this paragraph

9 devolve upon, and, to the extent judged nec10 essary by a court of competent jurisdiction, be

11 exercised by, the person appointed under State

12 law to act on the individual’s behalf.

13 ‘‘(D) CONSTRUCTION.—The rights speci14 fied in this paragraph are in addition to any

15 right an individual may have under the Ameri16 cans with Disabilities Act, section 504 of the

17 Rehabilitation Act of 1973, or under section

18 1919.

19 ‘‘(c) SCOPE OF SERVICES.—

20 ‘‘(1) IN GENERAL.—An eligible individual who

21 is receiving case-management services described in

22 subsection (b)(2) may receive the following services

23 under such individual’s treatment plan under the

24 State plan:
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1 ‘‘(A) Acute rehabilitation services, focusing

2 on intensive physical and cognitive restorative

3 services in the early months following injury.

4 ‘‘(B) Subacute rehabilitation in either in5 patient or outpatient settings.

6 ‘‘(C) Transitional living services to train

7 the individual for more independent living, with

8 an emphasis on compensating for the loss of

9 skills which may not be restored.

10 ‘‘(D) Lifelong living services for individuals

11 discharged from rehabilitation who require on12 going lifetime support.

13 ‘‘(E) Home care, including comprehensive

14 training for family or other informal caregivers.

15 ‘‘(F) Day treatment and other outpatient

16 programs in nonresidential settings.

17 ‘‘(G) Independent living services to allow

18 the individual to live at home with optimal per19 sonal control over services.

20 ‘‘(H) Behavior disorder treatment services

21 to address or resolve patterns of behavior which

22 prevent or hinder participation in active reha23 bilitation.

24 ‘‘(I) Respite and recreation services to aid

25 the individual and members of the individual’s
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1 family in adapting psychologically and environ2 mentally to residual deficits resulting from

3 brain injury.

4 ‘‘(J) Treatment for conditions related to

5 alcoholism and drug dependency.

6 ‘‘(2) WAIVER OF CERTAIN LIMITATIONS ON THE

7 EXPENDITURE OF FUNDS.—

8 ‘‘(A) IN GENERAL.—In accordance with

9 standards established by the State coordinator,

10 a State case-management program may waive

11 restrictions on the amount, duration, and scope

12 of services otherwise applicable under the State

13 plan for medical assistance under this title to

14 the extent necessary to carry out a treatment

15 plan for an individual.

16 ‘‘(B) HOME CARE SERVICES IN EXCESS OF

17 LIMITATIONS ESTABLISHED BY STATE COORDI18 NATOR.—In accordance with standards estab19 lished by the State coordinator, a State case20 management program may approve the use of

21 funds provided under the State plan for medical

22 assistance under this title to pay for home care

23 services when such home care services exceed

24 limitations established by the State coordinator.
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1 ‘‘(C) OUT-OF-STATE PLACEMENTS FOR

2 RESIDENTIAL REHABILITATION SERVICES.—In

3 accordance with standards established by the

4 State coordinator, a State case management

5 program may approve the use of funds provided

6 under the State plan for medical assistance

7 under this title to pay for out-of-State place8 ments for residential rehabilitation services.

9 ‘‘(3) SPECIAL RULE FOR PROVIDERS OF LIVING

10 SERVICES.—No living services described in para11 graph (1) may be provided to or on behalf of any

12 individual under this section unless the State case13 management program with which the individual is

14 enrolled has entered into an agreement with the en15 tity providing such services that specifies—

16 ‘‘(A) the living services to be provided,

17 ‘‘(B) the period of time over which such

18 services will be provided, and

19 ‘‘(C) the charges to the patient for provid20 ing such services.

21 ‘‘(d) ELIGIBILITY OF INDIVIDUALS TO RECEIVE

22 SERVICES.—

23 ‘‘(1) IN GENERAL.—An individual is eligible to

24 receive case-management services under this section

25 if the individual resides in a State that has imple-
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1 mented a case-management program that meets the

2 requirements of this section, is eligible to receive

3 medical assistance under a State plan under this

4 title, has suffered a traumatic brain injury (as de5 fined in paragraph (2)), and is moderately or se6 verely disabled (as defined in paragraph (3)).

7 ‘‘(2) TRAUMATIC BRAIN INJURY DEFINED.—

8 For purposes of this section, the term ‘traumatic

9 brain injury’ means a sudden insult or damage to

10 the brain or its coverings caused by an external

11 physical force which may produce a diminished or al12 tered state of consciousness, and which results in a

13 temporary or permanent impairment of cognitive or

14 mental abilities or physical functioning, or disturb15 ance of behavioral or emotional functioning. Such

16 term does not include any injuries of a degenerative

17 or congenital nature.

18 ‘‘(3) DEFINITIONS RELATING TO MODERATELY

19 OR SEVERELY DISABLED INDIVIDUALS.—

20 ‘‘(A) IN GENERAL.—For purposes of this

21 section, the term ‘moderately or severely dis22 abled’ means in the case of an individual 6

23 years of age or older, an individual who (with24 out regard to income or employment status) is
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1 certified under the case-management program

2 as—

3 ‘‘(i) needing substantial assistance or

4 supervision from another individual with at

5 least 2 activities of daily living (as defined

6 in subparagraph (C));

7 ‘‘(ii) needing substantial supervision

8 due to cognitive or other mental impair9 ment and needing substantial assistance or

10 supervision from another individual with at

11 least 1 activity of daily living or in comply12 ing with a daily drug regimen; or

13 ‘‘(iii) needing substantial supervision

14 from another individual due to behaviors

15 that are dangerous (to the individual or

16 others), disruptive, or difficult to manage.

17 ‘‘(B) MODERATELY OR SEVERELY DIS18 ABLED CHILD.—

19 ‘‘(i) IN GENERAL.—For purposes of

20 this section, the term ‘moderately or se21 verely disabled’ means, in the case of an

22 individual under 6 years of age, an individ23 ual who is certified under the State case

24 management program as suffering from

25 comparable levels of disability which would
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1 entitle such individual to benefits under

2 this title.

3 ‘‘(ii) COMPARABLE LEVELS OF DIS4 ABILITY.—For purposes of clause (i), the

5 term ‘comparable levels of disability’

6 means physical, cognitive, or other mental

7 impairments that limit the ability of an in8 dividual who is under 6 years of age to

9 perform activities of daily living appro10 priate for the age of the individual that are

11 comparable to the physical, cognitive, or

12 other mental impairments that limit the

13 ability of an individual 6 years of age or

14 older such that the individual is described

15 in clause (i), (ii), or (iii) of subparagraph

16 (A).

17 ‘‘(C) ACTIVITY OF DAILY LIVING DE18 FINED.—For purposes of this section, the term

19 ‘activity of daily living’ means any of the follow20 ing activities:

21 ‘‘(i) Bathing.

22 ‘‘(ii) Dressing.

23 ‘‘(iii) Transferring.

24 ‘‘(iv) Toileting.

25 ‘‘(v) Eating.
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1 ‘‘(4) COVERAGE OF INDIVIDUALS UNDER DIS2 ABILITY PROTECTIONS.—Individuals receiving serv3 ices through a State case-management program

4 under this section shall be considered to be individ5 uals with disabilities for purposes of the Americans

6 with Disabilities Act of 1990.

7 ‘‘(e) ADDITIONAL DUTIES OF STATE COORDINA8 TOR.—

9 ‘‘(1) PREVENTION OF TRAUMATIC BRAIN IN10 JURY.—The State coordinator shall establish a pro11 gram of activities related to preventing and reducing

12 the rate of traumatic brain injuries in the State.

13 ‘‘(2) TRAUMATIC BRAIN INJURY REGISTRY.—

14 ‘‘(A) IN GENERAL.—The State coordinator

15 shall establish and maintain a central registry

16 of individuals who sustain traumatic brain in17 jury using standards established by the Sec18 retary under subsection (f) in order to—

19 ‘‘(i) collect information to facilitate

20 the development of injury prevention,

21 treatment, and rehabilitation programs;

22 and

23 ‘‘(ii) ensure the provision to individ24 uals with traumatic brain injury of infor25 mation regarding appropriate public or pri-
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1 vate agencies that provide rehabilitative

2 services so that injured individuals may ob3 tain needed service to alleviate injuries and

4 avoid secondary problems, such as mental

5 illness and chemical dependency.

6 ‘‘(B) DISSEMINATION OF DATA.—The

7 State coordinator shall provide summary reg8 istry data to public and private entities to con9 duct studies using data collected by the trau10 matic brain injury registry established under

11 subparagraph (A). The State coordinator may

12 charge a fee for all expenses associated with the

13 provision of data or data analysis.

14 ‘‘(3) NOTIFICATION OF INJURIES TO JOB

15 TRAINING PROGRAMS.—Within a reasonable period

16 of time after receiving a report that an individual

17 has sustained a traumatic brain injury, the State co18 ordinator shall notify any State agency responsible

19 for employment services and job training and shall

20 forward the individual’s name and other identifying

21 information to such agency.

22 ‘‘(4) STANDARDS FOR MARKETING OF BRAIN

23 INJURY SERVICES.—The State coordinator, after

24 consultation with the advisory committee established

25 under paragraph (6), shall—
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1 ‘‘(A) monitor standards established by the

2 Secretary regarding the marketing of services

3 (by hospitals and other providers) to any indi4 vidual who has sustained traumatic brain injury

5 or family members of such individual,

6 ‘‘(B) disseminate such standards to State

7 case-management programs, and

8 ‘‘(C) furnish information about such stand9 ards to such individual and such family mem10 bers at the earliest appropriate opportunity

11 after such individual has sustained the injury.

12 Such standards shall include (at a minimum) a rule

13 prohibiting payments under a State case-manage14 ment program under this section for referring indi15 viduals to rehabilitation facilities.

16 ‘‘(5) STUDIES.—The State coordinator shall

17 collect injury incidence information (including the

18 prevalence, prevention, and treatment of traumatic

19 brain injury), analyze the information, and conduct

20 special studies regarding traumatic brain injury.

21 ‘‘(6) ESTABLISHMENT OF ADVISORY COMMIT22 TEE.—The State coordinator shall establish an advi23 sory committee (consisting of representatives of pro24 fessionals who provide community-based services

25 under this section and individuals with traumatic
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1 brain injuries and family members of such individ2 uals) to provide recommendations regarding the

3 needs of individuals with traumatic brain injuries,

4 provide advice on activities under paragraph (1), and

5 assist in the establishment of marketing standards

6 under paragraph (4).

7 ‘‘(7) PRIVACY.—Any data identifying specific

8 individuals which is collected by or provided to the

9 State coordinator may be used only for purposes of

10 case-management and rehabilitation and studies by

11 the State coordinator, in accordance with rules

12 adopted by the State coordinator.

13 ‘‘(8) ADOPTION OF STANDARDS FOR REPORT14 ING DATA AND OPERATION OF REGISTRIES.—The

15 State coordinator shall adopt such standards estab16 lished under subsection (f) as are necessary to carry

17 out this subsection. At a minimum, the State coordi18 nator shall adopt the standards relating to the mat19 ters identified in subparagraphs (A) through (E) of

20 subsection (f)(2).

21 ‘‘(9) ESTABLISHMENT OF REPORTING SYS22 TEM.—

23 ‘‘(A) IN GENERAL.—The State coordinator

24 shall design and establish a reporting system

25 which requires either the treating hospital, med-
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1 ical facility, or physician to report to the State

2 coordinator within a reasonable period of time

3 after the identification of any individual with

4 ICD diagnostic codes treated for a traumatic

5 brain injury in the State. The consent of the in6 jured individual is not required.

7 ‘‘(B) REPORT.—A report under subpara8 graph (A) shall include—

9 ‘‘(i) the name, age, and residence of

10 the injured individual;

11 ‘‘(ii) the date and cause of the injury;

12 ‘‘(iii) the initial diagnosis; and

13 ‘‘(iv) other information required by

14 the State coordinator.

15 ‘‘(C) LIABILITY PROTECTION.—The fur16 nishing of information pursuant to the system

17 established under subparagraph (A) shall not

18 subject any individual or facility to any action

19 for damages or other relief, provided that the

20 individual or facility acted in good faith in fur21 nishing the information.

22 ‘‘(f) STANDARDS FOR REPORTING DATA AND OPER23 ATION OF REGISTRIES.—

24 ‘‘(1) IN GENERAL.—Not later than January 1,

25 1995, the Secretary of Health and Human Services,
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1 acting through the Director of the Centers for Dis2 ease Control and Prevention, shall establish stand3 ards for the reporting of data on traumatic brain in4 juries and the operation of registries of traumatic

5 brain injuries for use by State coordinators under

6 this section.

7 ‘‘(2) SCOPE.—The standards established under

8 paragraph (1) shall at a minimum provide for—

9 ‘‘(A) the specific International Classifica10 tion of Diseases, Ninth Revision, Clinical Modi11 fication, diagnostic codes (hereafter referred to

12 in this subsection as ‘ICD diagnostic codes’) in13 cluded in the definitions of traumatic brain in14 jury;

15 ‘‘(B) the type of data to be reported;

16 ‘‘(C) standards for reporting specific types

17 of data;

18 ‘‘(D) the individuals and facilities required

19 to report and the time period in which reports

20 must be submitted; and

21 ‘‘(E) criteria relating to the use of registry

22 data by public and private entities engaged in

23 research.’’.

24 (c) BUDGET NEUTRALITY.—
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1 (1) IN GENERAL.—During the first 12-month

2 period a State provides case-management services to

3 which the amendments made by this section apply,

4 and each 12-month period thereafter, Federal finan5 cial participation for all services under a State plan

6 approved under title XIX of the Social Security Act

7 provided to individuals with traumatic brain injuries

8 shall not exceed the baseline amount determined

9 under paragraph (2).

10 (2) BASELINE AMOUNT.—

11 (A) FIRST YEAR.—The baseline amount

12 for the first 12-month period to which para13 graph (1) applies shall be equal to the sum of—

14 (i) the amount of Federal financial

15 participation attributable to all services

16 provided to individuals with traumatic

17 brain injuries under a State plan in the

18 12-month period prior to the inclusion of

19 case-management services in the State

20 plan, as certified by the Secretary, plus

21 (ii) such amount multiplied by the es22 timated percentage increase in the

23 Consumer Price Index for All-Urban Con24 sumers for the preceding 12-month period.
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1 (B) SUBSEQUENT YEARS.—The baseline

2 amount for any subsequent 12-month period

3 shall be equal to the sum of—

4 (i) the baseline amount for the pre5 ceding 12-month period, plus

6 (ii) such amount multiplied by the es7 timated percentage increase in the

8 Consumer Price Index for All-Urban Con9 sumers for the preceding 12-month period,

10 with appropriate adjustments to reflect

11 previous underestimations or overesti12 mations under this clause of subparagraph

13 (A)(ii).

14 (d) CONFORMING AMENDMENT.—Section 1915(g)(2)

15 of the Social Security Act (42 U.S.C. 1396n(g)(2)) is

16 amended by striking the period at the end and inserting

17 the following: ‘‘, but does not include any services provided

18 under section 1931.’’.

19 (e) AUTHORIZATION OF APPROPRIATIONS.—There

20 are authorized to be appropriated $5,000,000 for each fis21 cal year beginning with fiscal year 1995 to carry out para22 graphs (1) and (2) of section 1931(e) of the Social Secu23 rity Act (as added by subsection (b)).
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1 (f) EFFECTIVE DATE.—The amendments made by

2 subsections (a), (b), and (d) shall apply to calendar quar3 ters beginning on or after January 1, 1995.

4 SEC. 3. STUDY OF EFFECTIVENESS OF TRAUMATIC BRAIN

5 INJURY INTERVENTIONS.

6 (a) STUDY.—The Administrator of the Agency for

7 Health Care Policy and Research shall conduct a study

8 to identify common therapeutic interventions which are

9 used for the rehabilitation of traumatic brain injury pa10 tients, and shall include in the study an analysis of—

11 (1) the effectiveness of each such intervention

12 in improving the functioning of traumatic brain in13 jury patients; and

14 (2) the comparative effectiveness of interven15 tions employed in the course of rehabilitation of

16 traumatic brain injury patients to achieve the same

17 or similar clinical outcome.

18 (b) REPORT.—Not later than 3 years after the date

19 of the enactment of this Act, the Administrator of the

20 Agency for Health Care Policy and Research shall submit

21 a report on the study conducted under subsection (a) to

22 the Congress.

23 (c) AUTHORIZATION OF APPROPRIATIONS.—There

24 are authorized to be appropriated $2,000,000 for each of
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1 fiscal years 1994 through 1997 to carry out the purposes

2 of this section.

Æ