H. R. 3590—405 
‘‘(4) TRAUMA CENTERS IN 1115 WAIVER STATES.—Notwith-
standing paragraph (3), the Secretary may award a substantial 
uncompensated care grant to a trauma center under subsection 
(a)(1) if the trauma center qualifies for funds under a Low 
Income Pool or Safety Net Care Pool established through a 
waiver approved under section 1115 of the Social Security 
Act (42 U.S.C. 1315). 
‘‘(5) DESIGNATION.—The Secretary may not award a grant 
to a trauma center unless such trauma center is verified by 
the American College of Surgeons or designated by an equiva-
lent State or local agency. 
‘‘(c) ADDITIONAL REQUIREMENTS.—The Secretary may not award 
a grant to a trauma center under subsection (a)(1) unless such 
trauma center— 
‘‘(1) submits to the Secretary a plan satisfactory to the 
Secretary that demonstrates a continued commitment to 
serving trauma patients regardless of their ability to pay; and 
‘‘(2) has policies in place to assist patients who cannot 
pay for part or all of the care they receive, including a sliding 
fee scale, and to ensure fair billing and collection practices.’’. 
(2) CONSIDERATIONS IN MAKING GRANTS.—Section 1242 of 
the Public Health Service Act (42 U.S.C. 300d–42) is amended 
by striking subsections (a) and (b) and inserting the following: 
‘‘(a) SUBSTANTIAL UNCOMPENSATED CARE AWARDS.— 
‘‘(1) IN GENERAL.—The Secretary shall establish an award 
basis for each eligible trauma center for grants under section 
1241(a)(1) according to the percentage described in paragraph 
(2), subject to the requirements of section 1241(b)(3). 
‘‘(2) PERCENTAGES.—The applicable percentages are as fol-
lows: 
‘‘(A) With respect to a category A trauma center, 100 
percent of the uncompensated care costs. 
‘‘(B) With respect to a category B trauma center, not 
more than 75 percent of the uncompensated care costs. 
‘‘(C) With respect to a category C trauma center, not 
more than 50 percent of the uncompensated care costs. 
‘‘(b) CORE MISSION AWARDS.— 
‘‘(1) IN
GENERAL.—In awarding grants under section 
1241(a)(2), the Secretary shall— 
‘‘(A) reserve 25 percent of the amount allocated for 
core mission awards for Level III and Level IV trauma 
centers; and 
‘‘(B) reserve 25 percent of the amount allocated for 
core mission awards for large urban Level I and II trauma 
centers— 
‘‘(i) that have at least 1 graduate medical education 
fellowship in trauma or trauma related specialties for 
which demand is exceeding supply; 
‘‘(ii) for which— 
‘‘(I) annual uncompensated care costs exceed 
$10,000,000; or 
‘‘(II) at least 20 percent of emergency depart-
ment visits are charity or self-pay or Medicaid 
patients; and 
‘‘(iii) 
that 
are 
not 
eligible 
for 
substantial 
uncompensated care awards under section 1241(a)(1).
H. R. 3590—406 
‘‘(c) EMERGENCY AWARDS.—In awarding grants under section 
1241(a)(3), the Secretary shall— 
‘‘(1) give preference to any application submitted by a 
trauma center that provides trauma care in a geographic area 
in which the availability of trauma care has significantly 
decreased or will significantly decrease if the center is forced 
to close or downgrade service or growth in demand for trauma 
services exceeds capacity; and 
‘‘(2) reallocate any emergency awards funds not obligated 
due to insufficient, or a lack of qualified, applications to the 
significant uncompensated care award program.’’. 
(3) CERTAIN
AGREEMENTS.—Section 1243 of the Public 
Health Service Act (42 U.S.C. 300d–43) is amended by striking 
subsections (a), (b), and (c) and inserting the following: 
‘‘(a) MAINTENANCE OF FINANCIAL SUPPORT.—The Secretary may 
require a trauma center receiving a grant under section 1241(a) 
to maintain access to trauma services at comparable levels to the 
prior year during the grant period. 
‘‘(b) TRAUMA CARE REGISTRY.—The Secretary may require the 
trauma center receiving a grant under section 1241(a) to provide 
data to a national and centralized registry of trauma cases, in 
accordance with guidelines developed by the American College of 
Surgeons, and as the Secretary may otherwise require.’’. 
(4) GENERAL
PROVISIONS.—Section 1244 of the Public 
Health Service Act (42 U.S.C. 300d–44) is amended by striking 
subsections (a), (b), and (c) and inserting the following: 
‘‘(a) APPLICATION.—The Secretary may not award a grant to 
a trauma center under section 1241(a) unless such center submits 
an application for the grant to the Secretary and the application 
is in such form, is made in such manner, and contains such agree-
ments, assurances, and information as the Secretary determines 
to be necessary to carry out this part. 
‘‘(b) LIMITATION ON DURATION OF SUPPORT.—The period during 
which a trauma center receives payments under a grant under 
section 1241(a)(3) shall be for 3 fiscal years, except that the Sec-
retary may waive such requirement for a center and authorize 
such center to receive such payments for 1 additional fiscal year. 
‘‘(c) LIMITATION ON AMOUNT OF GRANT.—Notwithstanding sec-
tion 1242(a), a grant under section 1241 may not be made in 
an amount exceeding $2,000,000 for each fiscal year. 
‘‘(d) 
ELIGIBILITY.—Except 
as 
provided 
in 
section 
1242(b)(1)(B)(iii), acquisition of, or eligibility for, a grant under 
section 1241(a) shall not preclude a trauma center from being 
eligible for other grants described in such section. 
‘‘(e) FUNDING DISTRIBUTION.—Of the total amount appropriated 
for a fiscal year under section 1245, 70 percent shall be used 
for 
substantial 
uncompensated 
care 
awards 
under 
section 
1241(a)(1), 20 percent shall be used for core mission awards under 
section 1241(a)(2), and 10 percent shall be used for emergency 
awards under section 1241(a)(3). 
‘‘(f) MINIMUM ALLOWANCE.—Notwithstanding subsection (e), if 
the amount appropriated for a fiscal year under section 1245 is 
less than $25,000,000, all available funding for such fiscal year 
shall be used for substantial uncompensated care awards under 
section 1241(a)(1). 
‘‘(g) SUBSTANTIAL UNCOMPENSATED CARE AWARD DISTRIBUTION 
AND PROPORTIONAL SHARE.—Notwithstanding section 1242(a), of
H. R. 3590—407 
the amount appropriated for substantial uncompensated care grants 
for a fiscal year, the Secretary shall— 
‘‘(1) make available— 
‘‘(A) 50 percent of such funds for category A trauma 
center grantees; 
‘‘(B) 35 percent of such funds for category B trauma 
center grantees; and 
‘‘(C) 15 percent of such funds for category C trauma 
center grantees; and 
‘‘(2) provide available funds within each category in a 
manner proportional to the award basis specified in section 
1242(a)(2) to each eligible trauma center. 
‘‘(h) REPORT.—Beginning 2 years after the date of enactment 
of the Patient Protection and Affordable Care Act, and every 2 
years thereafter, the Secretary shall biennially report to Congress 
regarding the status of the grants made under section 1241 and 
on the overall financial stability of trauma centers.’’. 
(5) AUTHORIZATION OF APPROPRIATIONS.—Section 1245 of 
the Public Health Service Act (42 U.S.C. 300d–45) is amended 
to read as follows: 
‘‘SEC. 1245. AUTHORIZATION OF APPROPRIATIONS. 
‘‘For the purpose of carrying out this part, there are authorized 
to be appropriated $100,000,000 for fiscal year 2009, and such 
sums as may be necessary for each of fiscal years 2010 through 
2015. Such authorization of appropriations is in addition to any 
other authorization of appropriations or amounts that are available 
for such purpose.’’. 
(6) DEFINITION.—Part D of title XII of the Public Health 
Service Act (42 U.S.C. 300d–41 et seq.) is amended by adding 
at the end the following: 
‘‘SEC. 1246. DEFINITION. 
‘‘In this part, the term ‘uncompensated care costs’ means 
unreimbursed costs from serving self-pay, charity, or Medicaid 
patients, without regard to payment under section 1923 of the 
Social Security Act, all of which are attributable to emergency 
care and trauma care, including costs related to subsequent 
inpatient admissions to the hospital.’’. 
(b) TRAUMA SERVICE AVAILABILITY.—Title XII of the Public 
Health Service Act (42 U.S.C. 300d et seq.) is amended by adding 
at the end the following: 
‘‘PART H—TRAUMA SERVICE AVAILABILITY 
‘‘SEC. 1281. GRANTS TO STATES. 
‘‘(a) ESTABLISHMENT.—To promote universal access to trauma 
care services provided by trauma centers and trauma-related physi-
cian specialties, the Secretary shall provide funding to States to 
enable such States to award grants to eligible entities for the 
purposes described in this section. 
‘‘(b) AWARDING OF GRANTS BY STATES.—Each State may award 
grants to eligible entities within the State for the purposes described 
in subparagraph (d). 
‘‘(c) ELIGIBILITY.— 
‘‘(1) IN GENERAL.—To be eligible to receive a grant under 
subsection (b) an entity shall— 
‘‘(A) be—
H. R. 3590—408 
‘‘(i) a public or nonprofit trauma center or consor-
tium thereof that meets that requirements of para-
graphs (1), (2), and (5) of section 1241(b); 
‘‘(ii) a safety net public or nonprofit trauma center 
that meets the requirements of paragraphs (1) through 
(5) of section 1241(b); or 
‘‘(iii) a hospital in an underserved area (as defined 
by the State) that seeks to establish new trauma serv-
ices; and 
‘‘(B) submit to the State an application at such time, 
in such manner, and containing such information as the 
State may require. 
‘‘(2) LIMITATION.—A State shall use at least 40 percent 
of the amount available to the State under this part for a 
fiscal year to award grants to safety net trauma centers 
described in paragraph (1)(A)(ii). 
‘‘(d) USE OF FUNDS.—The recipient of a grant under subsection 
(b) shall carry out 1 or more of the following activities consistent 
with subsection (b): 
‘‘(1) Providing trauma centers with funding to support 
physician compensation in trauma-related physician specialties 
where shortages exist in the region involved, with priority 
provided to safety net trauma centers described in subsection 
(c)(1)(A)(ii). 
‘‘(2) Providing for individual safety net trauma center fiscal 
stability and costs related to having service that is available 
24 hours a day, 7 days a week, with priority provided to 
safety net trauma centers described in subsection (c)(1)(A)(ii) 
located in urban, border, and rural areas. 
‘‘(3) Reducing trauma center overcrowding at specific 
trauma centers related to throughput of trauma patients. 
‘‘(4) Establishing new trauma services in underserved areas 
as defined by the State. 
‘‘(5) Enhancing collaboration between trauma centers and 
other hospitals and emergency medical services personnel 
related to trauma service availability. 
‘‘(6) Making capital improvements to enhance access and 
expedite trauma care, including providing helipads and associ-
ated safety infrastructure. 
‘‘(7) Enhancing trauma surge capacity at specific trauma 
centers. 
‘‘(8) Ensuring expedient receipt of trauma patients trans-
ported by ground or air to the appropriate trauma center. 
‘‘(9) Enhancing interstate trauma center collaboration. 
‘‘(e) LIMITATION.— 
‘‘(1) IN
GENERAL.—A State may use not more than 20 
percent of the amount available to the State under this part 
for a fiscal year for administrative costs associated with 
awarding grants and related costs. 
‘‘(2) MAINTENANCE OF EFFORT.—The Secretary may not pro-
vide funding to a State under this part unless the State agrees 
that such funds will be used to supplement and not supplant 
State funding otherwise available for the activities and costs 
described in this part. 
‘‘(f) DISTRIBUTION OF FUNDS.—The following shall apply with 
respect to grants provided in this part: