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(1) by redesignating parts C through F as parts
D through G, respectively; and
(2) by inserting after part B the following new
part:
‘‘PART C—TRAUMATIC BRAIN INJURY
‘‘SEC. 1225. DEFINITIONS.
‘‘As used in this part:
‘‘(1) ADMINISTRATOR.—The term ‘Adminis-
trator’ means the Administrator of the Agency for
Health Care Policy and Research.
‘‘(2) DIRECTOR.—The term ‘Director’ means
the Director of the Centers for Disease Control and
Prevention.
‘‘(3) TRAUMATIC
BRAIN
INJURY.—The term
‘traumatic brain injury’ means an acquired injury to
the brain caused by an external physical force. Such
term does not include brain dysfunction caused by
congenital or degenerative disorders, nor does such
term include birth trauma. Such term is synonymous
with the term ‘head injury’.
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‘‘SEC. 1225A. AGENCY FOR HEALTH CARE POLICY AND RE-
SEARCH STUDY OF EFFECTIVENESS OF TRAU-
MATIC BRAIN INJURY INTERVENTIONS.
‘‘(a) IN GENERAL.—The Secretary, acting through
the Administrator, shall conduct a study concerning trau-
matic brain injury.
‘‘(b) MAJOR FINDINGS.—The study conducted under
subsection (a) shall seek to—
‘‘(1) identify common therapeutic interventions
which are used for the rehabilitation of individuals
with traumatic brain injuries, and shall include an
analysis of—
‘‘(A) the effectiveness of each such inter-
vention in improving the functioning of individ-
uals with brain injuries; and
‘‘(B) the comparative effectiveness of inter-
ventions employed in the course of rehabilita-
tion of individuals with brain injuries to achieve
the same or similar clinical outcome; and
‘‘(2) develop practice guidelines for the rehabili-
tation of traumatic brain injury.
‘‘(c) REPORTING REQUIREMENTS.—Not later than 4
years after the date of enactment of this part, the Sec-
retary shall prepare and submit to the appropriate com-
mittees of Congress, a report containing the results of the
studies conducted under this section.
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‘‘(d) AUTHORIZATION
OF APPROPRIATION.—There
are authorized to be appropriated to carry out this section,
$2,000,000 for fiscal year 1994, and such sums as may
be necessary for each of the fiscal years 1995 through
1996.
‘‘SEC. 1225B. CENTERS FOR DISEASE CONTROL AND PRE-
VENTION STUDY OF TRAUMATIC BRAIN IN-
JURY OCCURRENCE.
‘‘(a) IN GENERAL.—The Secretary, acting through
the Director, and in cooperation with other Public Health
Service agencies as may be necessary, shall conduct stud-
ies concerning traumatic brain injury, and shall establish
a reporting system under subsection (b).
‘‘(b) REPORTING SYSTEM.—To assist in data and in-
formation gathering, the Director shall establish a uniform
reporting system under which hospitals, State and local
health-related agencies will report to the Director on mat-
ters including—
‘‘(1) the occurrence of traumatic brain injuries;
and
‘‘(2) the health insurance status of individuals
with traumatic brain injury.
The reporting system should be established to permit the
Director to make an accurate assessment of resource
needs and long term outcomes.
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‘‘(c) SURVEY AND COOPERATIVE AGREEMENTS.—
‘‘(1) SURVEY.—The Director shall determine
which Federal, State, local or other entities collect
data on traumatic brain injury and the means by
which such entities collect such data.
‘‘(2) COOPERATIVE AGREEMENTS.—The Direc-
tor may enter into cooperative agreements with
other agencies, and provide assistance to other enti-
ties with responsibility for data collection, to estab-
lish traumatic brain injury as a specific reportable
condition in existing and future reporting systems.
Any data systems established in conjunction with
such agencies should be compatible with other such
data systems.
‘‘(d) MAJOR FINDINGS OF STUDIES.—The studies
conducted under subsection (a) shall seek to—
‘‘(1) determine the major causes of traumatic
brain injury;
‘‘(2) determine the preventive efforts that are
being used by States and non-profit agencies to re-
duce the occurrence of such injuries;
‘‘(3) determine the number of individuals sur-
viving traumatic brain injuries, and the cost of
treatment and other related costs;
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‘‘(4) develop a uniform reporting system to fa-
cilitate the reporting to the Centers for Disease Con-
trol and Prevention concerning the occurrence of
traumatic brain injury;
‘‘(5) identify States and localities that have ap-
proved mandated helmet use laws for bicyclist and
others;
‘‘(6) determine the health insurance status of
individuals with traumatic brain injury; and
‘‘(7) initiate a program of prevention research
to develop effective prevention of traumatic brain in-
jury.
‘‘(e) REPORTING REQUIREMENTS.—Not later than 4
years after the date of enactment of this part, the Sec-
retary shall prepare and submit to the appropriate com-
mittees of Congress, a report containing the results of the
studies conducted under this section.
‘‘(f) BIENNIAL REPORT.—The Secretary shall bienni-
ally prepare a report containing recommendations for the
prevention of traumatic brain injuries. The report shall
also identify States that have mandated helmet laws for
bicyclists and others. Such reports shall be disseminated
to State health officers.
‘‘(g) AUTHORIZATION
OF APPROPRIATION.—There
are authorized to be appropriated to carry out this section,
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$2,000,000 for fiscal year 1994, and such sums as may
be necessary for each of the fiscal years 1995 through
1996.
‘‘SEC. 1225C. SPECIAL PREVENTION PROJECTS.
‘‘(a) IN GENERAL.—The Secretary shall cooperate
with, and may provide assistance to, public and private
nonprofit entities to reduce the incidence of traumatic
brain injury through the establishment and effectuation
of prevention projects. In carrying out this section, the
Secretary may award grants to State and local entities,
and to public or non-profit private entities, to support—
‘‘(1) special prevention and public awareness
initiative projects;
‘‘(2) model traumatic brain injury prevention,
research and support programs;
‘‘(3) projects that study the service needs of in-
dividuals with traumatic brain injury; and
‘‘(4) projects involving grants for services co-
ordination.
‘‘(b) REQUIREMENTS.—To be eligible to receive as-
sistance under subsection (a), an entity shall—
‘‘(1) prepare and submit to the Secretary an
application, at such time, in such manner, and con-
taining such information as the Secretary may re-
quire; and
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‘‘(2) provide assurances to the Secretary that
any preventive measures implemented under a pre-
vention project funded under this section may in-
clude—
‘‘(A) behavioral and environmental inter-
ventions (such as physical restraints or helmets
for individuals using bicycles, in-line roller
skates, and skateboards);
‘‘(B) the use of innovative and proven
model prevention approaches;
‘‘(C) the promotion of activities that will
minimize brain injury risk in athletes (such as
the use of head protection gear); and
‘‘(D) the improvement of community-level
access to data-base systems to assist in design-
ing, developing, and implementing traumatic
brain injury prevention programs.
‘‘(c) AUTHORIZATION OF APPROPRIATIONS.—There
are authorized to be appropriated to carry out this section,
$4,000,000 for fiscal year 1994, and such sums as may
be necessary for each of the fiscal years 1995 and 1996.
‘‘SEC. 1225D. BASIC AND APPLIED RESEARCH.
‘‘(a) IN GENERAL.—The Secretary, acting through
the Director of the National Institutes of Health, may pro-
vide assistance to public and private nonprofit entities to
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support the conduct of basic and applied research concern-
ing traumatic brain injury, especially with respect to the
biomechanics of brain injury, the molecular and cellular
characteristics of primary and secondary injury to the
brain and the development of improved experimental brain
injury models.
‘‘(b) SPECIFIC RESEARCH.—Research to be con-
ducted with assistance provided under subsection (a) shall
be determined by the Secretary, prior to the provision of
such assistance, to contribute to the strategies that will
limit primary and secondary mechanical, biochemical and
metabolic insults to the brain and minimize the extent,
severity and progression of resulting dysfunctions. In im-
plementing this section the Secretary shall emphasize—
‘‘(1) the development of new methods and mo-
dalities for the more effective diagnosis, measure-
ment of degree of injury, post-injury monitoring and
prognostic assessment of head injury for acute,
subacute and later phases of care;
‘‘(2) the development, modification and evalua-
tion of therapies that retard, prevent or reverse
brain damage after acute head injury, that arrest
further deterioration following injury and that pro-
vide the restitution of function for individuals with
long-term injuries;
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‘‘(3) the integration of basic research into clini-
cal care settings;
‘‘(4) the development of a continuum of care
from acute care through rehabilitation, designed, to
the extent practicable, to integrate rehabilitation and
long-term outcome evaluation with acute care re-
search;
‘‘(5) the development of programs that increase
the participation of academic centers of excellence in
head injury treatment and rehabilitation research
and training; and
‘‘(6) the conduct of national consensus con-
ferences on managing head injury and related reha-
bilitation concerns, the findings of which shall be
published.
‘‘(c) AUTHORIZATION OF APPROPRIATIONS.—There
are authorized to be appropriated to carry out this section,
$5,000,000 for fiscal year 1994, and such sums as may
be necessary for each of the fiscal years 1995 and 1996.
‘‘SEC. 1225E. STATEWIDE PROGRAM FOR TRAUMATIC BRAIN
INJURY.
‘‘(a) GRANTS.—The Secretary shall award grants to
States for the establishment of programs related to trau-
matic brain injury. Such programs shall include State ad-
visory boards, patient advocacy and service coordination
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systems, and State registries concerning individuals af-
fected by traumatic brain injuries. Services may also be
provided under this section, within the limits of service
availability, to individuals whose deficits are not due to
traumatic brain injury. To be eligible for such services,
such individuals should be comparable to traumatic brain
injury patients in regard to the range of services needed,
the severity and duration of deficits, and the etiology of
their deficits being due to a nonprogressive and non-
recurring disorder.
‘‘(b) GENERAL ELIGIBILITY REQUIREMENTS.—To be
eligible to receive a grant under subsection (a), a State
shall—
‘‘(1) prepare and submit to the Secretary an
application, at such time, in such manner, and con-
taining such information as the Secretary may re-
quire;
‘‘(2) provide assurances that it will prepare and
submit to the Secretary reports describing the activi-
ties undertaken under the State system established
under the grant; and
‘‘(3) provide for the establishment of a State-
wide program that includes a State registry for trau-
matic brain injury information, a program of patient
advocacy and service coordination, and a State advi-
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sory board with respect to activities under this sec-
tion.
‘‘(c) SPECIFIC PROGRAM REQUIREMENTS.—
‘‘(1) STATE REGISTRY.—To be eligible to re-
ceive a grant under subsection (a), a State shall—
‘‘(A)(i) establish and maintain, through
the utilization of procedures to ensure privacy
and maintain the confidentiality of information,
which are acceptable to the Secretary, a central
registry of persons who sustain traumatic brain
injury in order to—
‘‘(I) collect information to facilitate
the development of injury prevention,
treatment, and rehabilitation programs;
and
‘‘(II) report data to the Director on
an annual basis for State reporting re-
quirements; and
‘‘(ii) provide that a violation of such pri-
vacy and confidentiality procedures or the un-
authorized use of such information may result
in a loss of support under this section; and
‘‘(B) provide summary registry data or
data that is not personally identifiable to public
and private entities to conduct studies using
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data collected by the traumatic brain injury
registry established under subparagraph (A),
for which the coordinator may charge a fee for
all expenses associated with the provision of
data or data analysis.
‘‘(2) ADVOCACY
AND
SERVICE
COORDINA-
TION.—To be eligible to receive a grant under sub-
section (a), a State shall—
‘‘(A) designate a State coordinator for
traumatic brain injuries who—
‘‘(i) shall establish policies and stand-
ards for coordinating services within the
State for individuals with traumatic brain
injury;
‘‘(ii) may contract with qualified agen-
cies or employ staff to provide services
under this section on a statewide basis to
eligible individuals;
‘‘(iii) shall be responsible for a pro-
gram of activities related to preventing and
reducing the rate of traumatic brain inju-
ries in the State according to standards es-
tablished by the Centers for Disease Con-
trol and Prevention; and
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‘‘(iv) shall, after consultation with the
State advisory board established under
paragraph (3), establish standards regard-
ing the marketing of services (by hospitals
and other providers) to traumatic brain in-
jury patients or family members, dissemi-
nate the standards to case management
programs, and furnish information on such
standards to individuals who sustain trau-
matic brain injuries (and the family mem-
bers of such individuals) at the earliest ap-
propriate opportunity after the individual
has sustained the injury (such standards to
include (at a minimum) a rule prohibiting
payments under a case management pro-
gram under this section for referring pa-
tients);
‘‘(B) provide assurances that a protection
and advocacy system established under this sec-
tion will—
‘‘(i) provide legal, administrative and
other appropriate remedies or approaches
to ensure the protection of, and advocacy
for, the rights of individuals with trau-
matic brain injury within the State who
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are or may be eligible for treatment, serv-
ices, or rehabilitation;
‘‘(ii) provide information and referral
to programs and services addressing the
needs of individuals with traumatic brain
injuries; and
‘‘(iii) provide for the investigation of
incidents of abuse and neglect of individ-
uals with traumatic brain injuries when in-
cidents are reported for the provision of
excessive or unnecessary services or other
complaints relating to the care of such in-
dividuals, and payment for the referral of
patients;
‘‘(C) ensure the provision to persons with
traumatic brain injury of information regarding
appropriate public or private agencies that pro-
vide rehabilitative services so that injured per-
sons or individuals responsible for such persons
may obtain needed service to alleviate injuries
and avoid secondary problems; and
‘‘(D) for purposes of identifying the serv-
ices required to prevent the institutionalization
or to minimize the need for residential rehabili-
tation in the case of traumatic brain injuries,
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establish a services coordination program that
shall—
‘‘(i) provide for the initial assessment
of the individual’s need for traumatic brain
injury services;
‘‘(ii) provide for the reassessment of
each patient at regular intervals to deter-
mine the extent of each patient’s progress,
to ascertain whether a patient is being
kept too long in a given setting or provided
services inappropriately, or to determine
whether the patient would be better served
by other services or in another setting;
‘‘(iii) prepare a treatment plan for
each individual requiring services coordina-
tion, within an appropriate period after the
individual sustains the injury, based on a
consultation with the individual (other
than an individual who is comatose in
which case consultation shall be with a
person with legal responsibility over such
individual) and any person named by the
individual (preparation of the plan may be
delayed based on a certification, including
a brief explanation of the reason for the
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delay, by a physician attesting that such a
delay is in the individual’s best interests
with a copy of the treatment plan and any
modifications to the plan being presented
to the individual or the individual’s legal
representative);
‘‘(iv) ensure that each individual’s
treatment plan is regularly updated (based
on consultation with the individual and the
person responsible for the injured individ-
ual) with data and information about
treatments and services provided, as well
as specific measures of the individual’s
current performance or activity relative to
goals previously established;
‘‘(v) assist the individual in obtaining
services necessary to allow the individual to
remain in the community;
‘‘(vi) coordinate home care services
with other services;
‘‘(vii) ensure appropriate, accessible,
and cost-effective services;
‘‘(viii) assist the individual with prob-
lems related to the provision of home care
services;
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‘‘(ix) ensure the quality of home care
services;
‘‘(x) assess the individual’s need for
and level of home care services at appro-
priate intervals during the course of the in-
dividual’s treatment under the program;
and
‘‘(xi) explore efforts to include serv-
ices coordination provisions under the
State’s medicaid program under section
1931 of the Social Security Act.
‘‘(3) STATE ADVISORY BOARD.—
‘‘(A) IN GENERAL.—To be eligible to re-
ceive a grant under subsection (a), a State shall
establish an advisory board within the appro-
priate health department of the State or within
another department as designated by the chief
executive officer of the State.
‘‘(B) FUNCTIONS.—An advisory board es-
tablished under subparagraph (A) shall be cog-
nizant of findings and concerns of Federal,
State and local agencies, citizens groups, and
private industry (such as insurance, health care,
automobile, and other industry entities). Such
advisory boards shall encourage citizen partici-
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pation through the establishment of public
hearings and other types of community out-
reach programs.
‘‘(C) COMPOSITION.—An advisory board
established under subparagraph (A) shall be
composed of—
‘‘(i) representatives of—
‘‘(I) 
the 
corresponding 
State
agencies involved;
‘‘(II) public and nonprofit private
health related organizations;
‘‘(III) other disability advisory or
planning groups within the State;
‘‘(IV) members of an organiza-
tion or foundation representing trau-
matic brain injury survivors in that
State; and
‘‘(V) injury control programs at
the State or local level if such pro-
grams exist; and
‘‘(ii) a substantial number of individ-
uals who are survivors of traumatic brain
injury, or the family members of such indi-
viduals.