I
103D CONGRESS
1ST SESSION
H. R. 2990
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
AUGUST 6, 1993
Mr. PALLONE (for himself, Mr. QUILLEN, and Mr. GREENWOOD) introduced
the following bill; which was referred to the Committee on Energy and
Commerce
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. SHORT TITLE.
This Act may be cited as the ‘‘Traumatic Brain
Injury Act of 1993’’.
SEC. 2. FINDINGS AND PURPOSE.
(a) FINDINGS.—Congress finds that—
(1) the incidence of head injury in the United
States is increasing, with over 2,000,000 head inju-
ries per year resulting from automobile crashes,
sports, recreational activities, assaults, violence and
other falls and incidents;
(2) a majority of all head injuries are caused by
motor vehicle accidents;
(3) individuals between the ages of 15 and 24
are at greatest risk for sustaining head injuries;
(4) of the individuals who sustain head injuries
each year, approximately 500,000 require hos-
pitalization, and 75,000 to 100,000 of such individ-
uals die within hours of the injury;
(5) of the individuals who survive head injuries
each year, approximately 70,000 to 90,000 will suf-
fer irreversible debilitating loss of function, 5,000
will develop epilepsy as a result of the injury, and
2,000 will exist in a coma;
(6) a significant number of individuals with
traumatic brain injury are not easily restored to so-
ciety and require years of rehabilitation, medical fol-
low-up and integrated community services, which are
costly and frequently not readily available;
(7) individuals sustaining traumatic brain in-
jury require coordinated and specialized services, in-
cluding post-injury supervised programs facilitating
reentry into the community;
(8) many health and social service agencies,
both public and private, overlook, exclude or inad-
equately serve individuals surviving traumatic brain
injury;
(9) society bears an economic cost of approxi-
mately $25,000,000,000 per year for the direct and
indirect costs of traumatic brain injury, which in-
clude medical treatment, rehabilitative and support
services and lost income;
(10) a program to develop national standards
for helmets used by bicyclists and others is needed;
and
(11) a national plan to provide services for indi-
viduals surviving traumatic brain injuries and their
families is needed.
(b) PURPOSE.—It is the purpose of this Act to—
(1) facilitate the conduct of research and the
collection and compiling of accurate statistical data
on traumatic brain injury;
(2) raise public awareness concerning the risks
and consequences of such injuries and the distinct
needs of individuals (and their families) following
survival from traumatic brain injury;
(3) to provide the public with all necessary and
relevant information about the prevention of trau-
matic brain injury, in order for individuals to make
informed and educated safety decisions;
(4) promote the creation of innovative programs
and policies to prevent traumatic brain injury and to
rehabilitate those individuals who have survived such
injuries;
(5) designate a Federal agency to oversee and
promote projects relating to the prevention of, and
rehabilitation from, traumatic brain injury;
(6) create State advisory boards to coordinate
citizen participation in community programs dealing
with traumatic brain injury;
(7) create a registry to advance epidemiologic
research on such trauma;
(8) establish standards for the marketing of
brain injury services;
(9) require the Secretary to publish various re-
ports concerning the activities of the Department of
Health and Human Services in this area, including
an annual review of relevant activities; and
(10) provide for the initiation of a program to
establish national standards for helmets used by
bicyclists and others.
SEC. 3. AMENDMENT TO PUBLIC HEALTH SERVICE ACT.
Title XII of the Public Health Service Act (42 U.S.C.
300d et seq.) is amended—
(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’.
‘‘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.
‘‘(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
matters 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.
‘‘(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;
‘‘(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;
‘‘(6) identify States and localities that have im-
plemented unique approaches to encouraging bicycle
helmet use;
‘‘(7) determine the health insurance status of
individuals with traumatic brain injury; and
‘‘(8) 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, as well as States that have unique bicycle hel-
met-use promotion programs in place. Such reports shall
be disseminated to State health officers.
‘‘(g) 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. 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—