(2), reallocate the funds for grants under section 
1241(a)(1) to other qualifying centers; and 
‘‘(4) subject to paragraphs (1), (2), and (3), en-
sure 
that 
funding 
for 
grants 
under 
section 
1241(a)(1) is divided equally among qualified appli-
cants. 
‘‘(b) CORE MISSION.—In making grants under sec-
tion 1241(a)(2), the Secretary shall— 
‘‘(1) reserve 25 percent of the amount allocated 
pursuant to section 1246(b)(2) for grants to level III 
and level IV trauma centers, but shall reallocate the 
funds to level I and level II centers if there are not 
sufficient qualifying level III and IV centers to obli-
gate the 25 percent set-aside; and 
‘‘(2) give preference to— 
‘‘(A) any application made by a trauma 
center in a geographic area where growth in de-
mand for trauma services exceeds capacity, as 
determined by the Secretary based on such fac-
tors as local and regional population trends, 
loss or downgrading of neighborhood trauma 
centers, loss or reduction of physician trauma 
specialty availability, high malpractice liability 
costs, or the necessity to provide physician on- 
call pay; or 
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‘‘(B) any application made by a trauma 
center which demonstrates State or political 
subdivision financial support. 
For any of the purposes specified in section 
1241(a)(2) for each fiscal year during which pay-
ments are made to the center from the grant, such 
financial support may be demonstrated by, but is 
not limited to, State or political subdivision funding 
for the trauma center’s capital or operating expenses 
including through State trauma regional advisory co-
ordination activities or Medicaid funding under title 
XIX of the Social Security Act designated for trau-
ma services, or other governmental funding. State 
funding derived from Federal support provided 
through the Trauma Systems Planning Grants pro-
vided to States or political subdivisions does not con-
stitute State or local financial support for purposes 
of preferential treatment under this section. 
‘‘(c) EMERGENCY RELIEF.—In making grants under 
section 1241(a)(3), the Secretary— 
‘‘(1) shall give preference to any application 
made by a trauma center that— 
‘‘(A) is providing trauma care in a geo-
graphic area in which the availability of trauma 
care has either significantly decreased as a re-
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sult of a trauma center in the area permanently 
ceasing participation in such system as of the 
date on which the application is submitted, or 
where growth in demand for trauma services 
exceeds capacity, as determined by the Sec-
retary based on such factors as local and re-
gional population trends, loss or downgrading of 
neighboring trauma centers, loss or reduction of 
physician specialty availability, high malpractice 
liability costs, or the necessity to provide physi-
cian on-call pay; 
‘‘(B) will, in providing trauma care during 
the 1-year period beginning on the date on 
which the application for the grant is sub-
mitted, incur uncompensated care costs in an 
amount rendering the center unable to continue 
participation in such system, resulting in a sig-
nificant decrease in the availability of trauma 
care in the geographic area; 
‘‘(C) operates in a rural area where trau-
ma care availability will significantly decrease if 
the trauma center is forced to close or down-
grade service and uncompensated care costs are 
contributing to a likelihood of closure or down-
grade; or 
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‘‘(D) the Secretary determines warrants fi-
nancial assistance if the trauma center is in a 
geographic location substantially affected by a 
natural disaster or other catastrophic event 
such as a terrorist attack; and 
‘‘(2) shall reallocate any funds available for 
grants under section 1241(a)(3), but not awarded 
due to insufficient or a lack of qualified applications, 
to grants under section 1241(a)(1). 
‘‘(d) 
INFORMATION
TECHNOLOGY.—In 
making 
grants under section 1241(a)(4), the Secretary shall— 
‘‘(1) make grants only to applicants who are eli-
gible to receive a grant under section 1241(a)(1); 
‘‘(2) give preference to qualified applicants 
who— 
‘‘(A) demonstrate the greatest financial 
need; and 
‘‘(B) are level I or level II centers; and 
‘‘(3) not make an award less than $1,000,000 
for a fiscal year unless such award would cover the 
full cost of an applicant’s proposed project. 
‘‘(e) DESIGNATIONS OF LEVELS OF TRAUMA CEN-
TERS IN CERTAIN STATES.—In the case of a State which 
has not designated 4 levels of trauma centers in the man-
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ner described in this section, any reference in this section 
to— 
‘‘(1) a level I or level II trauma center is 
deemed to be a reference to a trauma center within 
the highest two levels of trauma centers designated 
under State guidelines; and 
‘‘(2) a level III or IV trauma center is deemed 
to be a reference to a trauma center not within such 
highest two levels.’’. 
(c) CERTAIN AGREEMENTS.—Section 1243 of the 
Public Health Service Act (42 U.S.C. 300d–43) is amend-
ed to read as follows: 
‘‘SEC. 1243. CERTAIN AGREEMENTS. 
‘‘(a) COMMITMENT REGARDING CONTINUED PAR-
TICIPATION IN TRAUMA CARE SYSTEM.—The Secretary 
may not make a grant under section 1241(a)(1) (relating 
to uncompensated care costs) unless the trauma center in-
volved agrees that— 
‘‘(1) the center will continue participation in 
the system described in section 1241(b)(1), except 
as provided in section 1241(b)(2), throughout the 
grant period; and 
‘‘(2) if the center violates the agreement made 
pursuant to paragraph (1), the center will be liable 
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