Union Calendar No. 331
104TH CONGRESS
2D SESSION
H. R. 248
[Report No. 104–652]
A BILL
To amend the Public Health Service Act to provide
for the conduct of expanded studies and the es-
tablishment of innovative programs with respect
to traumatic brain injury, and for other pur-
poses.
JUNE 27, 1996
Reported with an amendment, committed to the Commit-
tee of the Whole House on the State of the Union, and
ordered to be printed
IB
Union Calendar No. 331
104TH CONGRESS
2D SESSION H. R. 248
[Report No. 104–652]
To amend the Public Health Service Act to provide for the conduct of
expanded studies and the establishment of innovative programs with
respect to traumatic brain injury, and for other purposes.
IN THE HOUSE OF REPRESENTATIVES
JANUARY 4, 1995
Mr. GREENWOOD (for himself and Mr. PALLONE) introduced the following bill;
which was referred to the Committee on Commerce
JUNE 27, 1996
Additional sponsors: Ms. LOFGREN, Mr. GEJDENSON, Mr. EHLERS, Mr.
HUTCHINSON, Mr. SERRANO, Mr. LEWIS of Georgia, Mr. QUILLEN, Mr.
DAVIS, Mr. SMITH of New Jersey, Mr. FOLEY, Mr. MINETA, Mr.
STUDDS, Mr. WATTS of Oklahoma, Mr. BEILENSON, Mr. FRAZER, Mr.
ENGLISH of Pennsylvania, Mr. BOUCHER, Mr. BALDACCI, Mr. LIPINSKI,
Mr. WAXMAN, Mr. ACKERMAN, Mrs. MORELLA, Mr. HAMILTON, Mr.
STARK, Mr. STEARNS, Mr. LEACH, Mr. MORAN, Ms. NORTON, Ms.
ESHOO, Mr. GUTIERREZ, Mr. UPTON, Mr. THORNBERRY, Mr. FRANK of
Massachusetts, and Mr. HOBSON
JUNE 27, 1996
Reported with an amendment, committed to the Committee of the Whole
House on the State of the Union, and ordered to be printed
[Strike out all after the enacting clause and insert the part printed in italic]
[For text of introduced bill, see copy of bill as introduced on January 4, 1995]
A BILL
To amend the Public Health Service Act to provide for
the conduct of expanded studies and the establishment
of innovative programs with respect to traumatic brain
injury, and for other purposes.
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled,
SECTION 1. PROGRAMS OF CENTERS FOR DISEASE CON-
TROL AND PREVENTION.
Part J of title III of the Public Health Service Act
(42 U.S.C. 280b et seq.) is amended by inserting after sec-
tion 393 the following section:
‘‘PREVENTION OF TRAUMATIC BRAIN INJURY
‘‘SEC. 393A. (a) IN GENERAL.—The Secretary, acting
through the Director of the Centers for Disease Control and
Prevention, may carry out projects to reduce the incidence
of traumatic brain injury. Such projects may be carried
out by the Secretary directly or through awards of grants
or contracts to public or nonprofit private entities. The Sec-
retary may directly or through such awards provide tech-
nical assistance with respect to the planning, development,
and operation of such projects.
‘‘(b) CERTAIN
ACTIVITIES.—Activities under sub-
section (a) may include—
‘‘(1) the conduct of research into identifying ef-
fective strategies for the prevention of traumatic brain
injury; and
‘‘(2) the implementation of public information
and education programs for the prevention of such in-
jury and for broadening the awareness of the public
concerning the public health consequences of such in-
jury.
‘‘(c) COORDINATION OF ACTIVITIES.—The Secretary
shall ensure that activities under this section are coordi-
nated as appropriate with other agencies of the Public
Health Service that carry out activities regarding trau-
matic brain injury.
‘‘(d) DEFINITION.—For purposes of this section, the
term ‘traumatic brain injury’ means an acquired injury
to the brain. Such term does not include brain dysfunction
caused by congenital or degenerative disorders, nor birth
trauma, but may include brain injuries caused by anoxia
due to near drowning. The Secretary may revise the defini-
tion of such term as the Secretary determines necessary.’’.
SEC. 2. PROGRAMS OF NATIONAL INSTITUTES OF HEALTH.
Section 1261 of the Public Health Service Act (42
U.S.C. 300d–61) is amended—
(1) in subsection (d)—
(A) in paragraph (2), by striking ‘‘and’’
after the semicolon at the end;
(B) in paragraph (3), by striking the period
and inserting ‘‘; and’’; and
(C) by adding at the end the following
paragraph:
‘‘(4) the authority to make awards of grants or
contracts to public or nonprofit private entities for
the conduct of basic and applied research regarding
traumatic brain injury, which research may in-
clude—
‘‘(A) the development of new methods and
modalities for the more effective diagnosis, meas-
urement of degree of injury, post-injury monitor-
ing and prognostic assessment of head injury for
acute, subacute and later phases of care;
‘‘(B) the development, modification and
evaluation of therapies that retard, prevent or
reverse brain damage after acute head injury,
that arrest further deterioration following injury
and that provide the restitution of function for
individuals with long-term injuries;
‘‘(C) the development of research on a con-
tinuum of care from acute care through rehabili-
tation, designed, to the extent practicable, to in-
tegrate rehabilitation and long-term outcome
evaluation with acute care research; and
‘‘(D) the development of programs that in-
crease the participation of academic centers of
excellence in head injury treatment and rehabili-
tation research and training.’’; and
(2) in subsection (h), by adding at the end the
following paragraph:
‘‘(4) The term ‘traumatic brain injury’ means
an acquired injury to the brain. Such term does not
include brain dysfunction caused by congenital or de-
generative disorders, nor birth trauma, but may in-
clude brain injuries caused by anoxia due to near
drowning. The Secretary may revise the definition of
such term as the Secretary determines necessary.’’.
SEC. 3. PROGRAMS OF HEALTH RESOURCES AND SERVICES
ADMINISTRATION.
Part E of title XII of the Public Health Service Act
(42 U.S.C. 300d–51 et seq.) is amended by adding at the
end the following section:
‘‘SEC. 
1252. 
STATE 
GRANTS 
FOR 
DEMONSTRATION
PROJECTS REGARDING TRAUMATIC BRAIN
INJURY.
‘‘(a) IN GENERAL.—The Secretary, acting through the
Administrator of the Health Resources and Services Admin-
istration, may make grants to States for the purpose of car-
rying out demonstration projects to improve access to health
and other services regarding traumatic brain injury.
‘‘(b) STATE ADVISORY BOARD.—
‘‘(1) IN GENERAL.—The Secretary may make a
grant under subsection (a) only if the State involved
agrees to establish an advisory board within the ap-
propriate health department of the State or within
another department as designated by the chief execu-
tive officer of the State.
‘‘(2) FUNCTIONS.—An advisory board established
under paragraph (1) shall advise and make rec-
ommendations to the State on ways to improve serv-
ices coordination regarding traumatic brain injury.
Such advisory boards shall encourage citizen partici-
pation through the establishment of public hearings
and other types of community outreach programs. In
developing recommendations under this paragraph,
such boards shall consult with Federal, State, and
local governmental agencies and with citizens groups
and other private entities.
‘‘(3) COMPOSITION.—An advisory board estab-
lished under paragraph (1) shall be composed of—
‘‘(A) 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 organization or
foundation representing traumatic brain in-
jury survivors in that State; and
‘‘(v) injury control programs at the
State or local level if such programs exist;
and
‘‘(B) a substantial number of individuals
who are survivors of traumatic brain injury, or
the family members of such individuals.
‘‘(c) MATCHING FUNDS.—
‘‘(1) IN GENERAL.—With respect to the costs to
be incurred by a State in carrying out the purpose
described in subsection (a), the Secretary may make
a grant under such subsection only if the State agrees
to make available, in cash, non-Federal contributions
toward such costs in an amount that is not less than
$1 for each $2 of Federal funds provided under the
grant.
‘‘(2) DETERMINATION
OF
AMOUNT
CONTRIB-
UTED.—In determining the amount of non-Federal
contributions in cash that a State has provided pur-
suant to paragraph (1), the Secretary may not in-
clude any amounts provided to the State by the Fed-
eral Government.
‘‘(d) APPLICATION FOR GRANT.—The Secretary may
make a grant under subsection (a) only if an application
for the grant is submitted to the Secretary and the applica-
tion is in such form, is made in such manner, and contains
such agreements, assurances, and information as the Sec-
retary determines to be necessary to carry out this section.
‘‘(e) COORDINATION OF ACTIVITIES.—The Secretary
shall ensure that activities under this section are coordi-
nated as appropriate with other agencies of the Public
Health Service that carry out activities regarding trau-
matic brain injury.
‘‘(f) REPORT.—Not later than 2 years after the date
of the enactment of this section, the Secretary shall submit
to the Committee on Commerce of the House of Representa-
tives, and to the Committee on Labor and Human Re-
sources of the Senate, a report describing the findings and
results of the programs established under this section, in-
cluding measures of outcomes and consumer and surrogate
satisfaction.
‘‘(g) DEFINITION.—For purposes of this section, the
term ‘traumatic brain injury’ means an acquired injury
to the brain. Such term does not include brain dysfunction
caused by congenital or degenerative disorders, nor birth
trauma, but may include brain injuries caused by anoxia
due to near drowning. The Secretary may revise the defini-
tion of such term as the Secretary determines necessary.
‘‘(h) AUTHORIZATION OF APPROPRIATIONS.—For the
purpose of carrying out this section, there is authorized to
be appropriated $5,000,000 for each of the fiscal years 1997
through 1999.’’.
SEC. 4. STUDY; CONSENSUS CONFERENCE.
(a) STUDY.—
(1) IN GENERAL.—The Secretary of Health and
Human Services (in this section referred to as the
‘‘Secretary’’), acting through the appropriate agencies
of the Public Health Service, shall conduct a study for
the purpose of carrying out the following with respect
to traumatic brain injury:
(A) In collaboration with appropriate State
and local health-related agencies—
(i) determine the incidence and preva-
lence of traumatic brain injury; and
(ii) develop a uniform reporting sys-
tem under which States report incidents of
traumatic brain injury, if the Secretary de-
termines that such a system is appropriate.
(B) Identify common therapeutic interven-
tions which are used for the rehabilitation of in-
dividuals with such injuries, and shall, subject to
the availability of information, include an anal-
ysis of—
(i) the effectiveness of each such inter-
vention in improving the functioning of in-
dividuals with brain injuries;
(ii) the comparative effectiveness of
interventions employed in the course of re-
habilitation of individuals with brain inju-
ries to achieve the same or similar clinical
outcome; and
(iii) the adequacy of existing measures
of outcomes and knowledge of factors influ-
encing differential outcomes.
(C) Develop practice guidelines for the reha-
bilitation of traumatic brain injury at such time
as appropriate scientific research becomes avail-
able.
(2) DATES CERTAIN FOR REPORTS.—
(A) Not later than 18 months after the date
of the enactment of this Act, the Secretary shall
submit to the Committee on Commerce of the
House of Representatives, and to the Committee
on Labor and Human Resources of the Senate,
a report describing the findings made as a result
of carrying out paragraph (1)(A).
(B) Not later than 3 years after the date of
the enactment of this Act, the Secretary shall
submit to the Committees specified in subpara-
graph (A) a report describing the findings made
as a result of carrying out subparagraphs (B)
and (C) of paragraph (1).
(b) CONSENSUS CONFERENCE.—The Secretary, acting
through the Director of the National Center for Medical Re-
habilitation Research within the National Institute for
Child Health and Human Development, shall conduct a na-
tional consensus conference on managing traumatic brain
injury and related rehabilitation concerns.
(c) DEFINITION.—For purposes of this section, the
term ‘‘traumatic brain injury’’ means an acquired injury
to the brain. Such term does not include brain dysfunction
caused by congenital or degenerative disorders, nor birth
trauma, but may include brain injuries caused by anoxia
due to near drowning. The Secretary may revise the defini-
tion of such term as the Secretary determines necessary.
(d) AUTHORIZATIONS OF APPROPRIATIONS.—For the
purpose of carrying out subsection (a)(1)(A), there is au-
thorized to be appropriated $3,000,000 for each of the fiscal
years 1997 through 1999. For the purpose of carrying out
the other provisions of this section, there is authorized to
be appropriated an aggregate $500,000 for the fiscal years
1997 through 1999. Amounts appropriated for such other
provisions remain available until expended.
SEC. 5. TECHNICAL AMENDMENTS.
Title XXVI of the Public Health Service Act (42 U.S.C.
300ff–11 et seq.), as amended by Public Law 104–146 (the
Ryan White CARE Act Amendments of 1996), is amend-
ed—
(1) in section 2626—
(A) in subsection (d), in the first sentence,
by striking ‘‘(1) through (5)’’ and inserting ‘‘(1)
through (4)’’; and
(B) in subsection (f), in the matter preced-
ing paragraph (1), by striking ‘‘(1) through (5)’’
and inserting ‘‘(1) through (4)’’; and
(2) in section 2692—
(A) in subsection (a)(1)(A)—
(i) by striking ‘‘title XXVI programs’’
and inserting ‘‘programs under this title’’;
and